Utilization Management Nurse Consultant
About The Position
CVS Health is hiring a remote Registered Nurse for its Utilization Management team. The role reviews clinical information to support coverage determinations and care decisions, applies clinical guidelines and nursing judgment across the continuum of care, and collaborates with providers and interdisciplinary teams on care coordination and treatment plans. The nurse also identifies opportunities to improve healthcare quality, benefit utilization, and member outcomes, and refers members to appropriate programs and services. This is a full-time position with an anticipated 40-hour workweek in a 24/7 operation. Scheduling flexibility is required for evenings, weekends, and holidays. Candidates in CST or EST time zones are preferred. Work-from-home colleagues must work within the state and city where they have confirmed they currently live and meet the stated internet, privacy, and workspace requirements. CVS Health provides equipment such as a computer, monitor, keyboard, and headset; colleagues provide their own desk or standing desk. The role requires an associate degree in nursing and an active, unrestricted RN license in the candidate’s state of residence. Applicants need at least two years of RN experience in adult acute care or critical care. A BSN and at least two years of Med-Surg or specialty clinical experience are preferred, as is managed care or utilization management experience. The stated pay range is $29.10–$62.32 per hour. The position is also eligible for a CVS Health bonus, commission, or short-term incentive program. Benefits for eligible full-time colleagues include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.
Requirements
- Active, unrestricted RN license in the state of residence.
- At least 2 years of RN experience in adult acute care or critical care settings.
- Strong clinical assessment, communication, and multitasking skills.
- Comfort working in a fast-paced, technology-driven environment.
- Associate degree in nursing required.
- Must meet work-from-home requirements, including a direct/hardwired internet connection to a modem/router within 7 feet of the computer, minimum speeds of 25 Mbps download and 3 Mbps upload, and no Wi-Fi or satellite internet.
- Must maintain a quiet, secure, private, tidy, and organized designated home workspace compliant with CVS Health and HIPAA guidelines, with the ability to work uninterrupted during work hours.
- Must work within the state and city where currently confirmed to live.
- Must provide own workspace furniture, such as a desk or standing desk, and commit to meeting internet speed and work-from-home requirements if hired.
- Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
- Ability to communicate using digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
- Experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
- Ability to access secure systems such as VPNs and EHR portals, secure devices and passwords, and recognize suspicious emails or links.
- Ability to troubleshoot common technical issues independently and contact IT for unresolved issues.
- Openness to learning new skills as the workplace environment evolves.
Nice To Haves
- At least 2 years of Med-Surg or specialty clinical experience.
- Managed Care and/or Utilization Management experience.
- BSN.
Responsibilities
- Review and assess clinical information to support coverage determinations and care decisions.
- Apply clinical guidelines, policies, and nursing judgment across the continuum of care.
- Collaborate with providers and interdisciplinary teams to coordinate care and treatment plans.
- Identify opportunities to improve healthcare quality, benefit utilization, and member outcomes.
- Refer members to appropriate programs and services that support comprehensive care.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility
- Eligible for a CVS Health bonus, commission, or short-term incentive program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
