Utilization Management Nurse Consultant

Fully remote UM Nurse Consultant role with CVS Health. Schedule is Wednesday–Sunday, 9am–6pm EST; UM is a 24/7 operation so weekends, holidays, and evening hours may be required.

Use clinical experience to assess, plan, implement, coordinate, monitor, and evaluate options that facilitate appropriate healthcare services and benefits for members. Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, and procedures along with clinical judgment to render coverage determinations and recommendations along the continuum of care.

Communicate with providers and other parties to facilitate care and treatment, identify members for referral to other products, services, and programs, and identify opportunities to promote quality and effective benefit utilization. Consult and lend expertise to internal and external partners on utilization and benefit management.

Required: 3+ years RN experience, active unrestricted RN license in state of residence, comfort working across multiple IT platforms, and 1+ year of Microsoft Office (Outlook, Teams, Excel). ADN required; BSN preferred. Preferred: prior authorization experience, outpatient clinical experience, Medicare/Medicaid knowledge, managed care, and prior UM experience.

Pay range: $32.01–$68.55/hour, plus bonus or short-term incentive eligibility.