UM Nurse Consultant

CVS Health Corporation; New York (NY); On-site; USD 91,722,000 - 196,424,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs and other resources

Job summary

CVS Health is seeking a UM Nurse Consultant to review cases, assess medical necessity, and coordinate care in a remote setting for adult patients.

The role emphasizes evidence-based criteria, collaboration with providers and care teams, and opportunities to improve quality, outcomes, and benefit utilization while serving as a clinical resource.

Qualifications

• Associate Degree in Nursing is required, BSN preferred.
• 2+ years of RN experience in an adult acute care or critical care setting.
• Active, unrestricted RN license in your state of residence required.

Responsibilities

• Review clinical information and apply evidence-based criteria to support coverage determinations and care recommendations.
• Collaborate with providers, care teams, and internal partners to coordinate treatment and services.
• Identify opportunities to improve healthcare quality, outcomes, and benefit utilization.
• Refer members to appropriate programs and services that support their overall health needs.
• Serve as a clinical resource for utilization and benefit management questions.

Skills

RN experience

Clinical review

Utilization management

Education

Associate Degree in Nursing

BSN preferred

Job description

About This Role

The UM Nurse Consultant at CVS Health is responsible for utilizing clinical expertise to review cases, assess medical necessity, and coordinate care within a remote setting. This role is ideal for experienced Registered Nurses looking to impact patient care through utilization management.

Highlights

• Pay: $32.01 - $68.55/hour


• Location: Remote, NY


• Schedule: Full-time

What You'll Do

• Review clinical information and apply evidence-based criteria to support coverage determinations and care recommendations.


• Collaborate with providers, care teams, and internal partners to coordinate treatment and services.


• Identify opportunities to improve healthcare quality, outcomes, and benefit utilization.


• Refer members to appropriate programs and services that support their overall health needs.


• Serve as a clinical resource for utilization and benefit management questions.

Requirements

• Education
  
  
  
  • Associate Degree in Nursing required, BSN preferred.
  
  
  
  


• Experience
  
  
  
  • 2+ years of RN experience in an adult acute care or critical care setting.
  
  
  
  


• Licenses & Certifications
  
  
  
  • Active, unrestricted RN license in your state of residence required.
  
  
  
  

Benefits

• Medical, dental, and vision coverage


• Paid time off


• Retirement savings options


• Wellness programs and other resources based on eligibility

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on creating a more connected, convenient, and compassionate health experience for individuals and communities.