Utilization Management Nurse Consultant (Must live in Pacific Time Zone.)

Hispanic Alliance for Career Enhancement; Remote; EUR 40.000 - 60.000; Vollzeit

Zusammenfassung

A leading health care provider is seeking a UM Nurse Consultant to assure quality healthcare delivery. This role requires an active RN license and 3+ years of clinical experience. Responsibilities include reviewing services for medical necessity and coordinating members' healthcare. Offering full-time hours with a compensation range of $29.10 to $68.55 per hour. The organization provides a comprehensive benefits package to support the well-being of employees and their families.

Leistungen

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings and counseling

Tuition assistance

Qualifikationen

• 3+ years of clinical experience as an RN in various settings.
• Active and unrestricted state licensure required.
• Ability to manage multiple priorities effectively.

Aufgaben

• Reviews services to assure medical necessity.
• Utilizes clinical expertise for benefit utilization and discharge planning.
• Coordinates and communicates healthcare services for members.

Kenntnisse

Clinical experience as an RN

Strong telephonic communication skills

Time-management skills

Decision-making skills

Ausbildung

Associates Degree in Nursing

BSN preferred

Tools

Microsoft Office Suite

Jobbeschreibung

Position Summary

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

Normal Working Hours

• Monday through Friday between 8am-5pm PST.
• Weekend shift requirement (Saturday and Sunday both) per the needs of the team.
• Holiday rotation per the need of the department (typically 1 holiday per year).

There is no travel expected with this position.

The UM Nurse Consultant job duties

• Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.
• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Required Qualifications

• Must reside in PST zone.
• RN with active and unrestricted state licensure in state of residence.
• 3+ years of clinical experience as an RN, preferably in Med/Surg, Telemetry, ICU, NICU, Long‑term care, or cardiology.

Preferred Qualifications

• 1+ years’ experience in either Precertification or Utilization Review.
• 1+ years’ experience Managed Care.
• Strong telephonic communication skills.
• 1+ years’ experience with Microsoft Office Suite (PowerPoint, Word, Excel, Outlook).
• Experience with computers toggling between screens while using a keyboard and speaking to customers.
• Ability to exercise independent and sound judgment, strong decision‑making skills, and well‑developed interpersonal skills.
• Ability to manage multiple priorities, effective organizational and time‑management skills required.
• Ability to use a computer station and sit for extended periods of time.

Education

• Associates Degree in Nursing required, BSN preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

Typical pay range for this role is:
$29.10 - $68.55
This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No‑cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 01/03/2026.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.