Utilization Management Nurse Consultant

CVS Health; United States; Remote; Full time

Job summary

An established industry player in health solutions is seeking a dedicated RN for a telework position. This role involves using critical thinking and clinical practice guidelines to review and authorize medical procedures. With a focus on patient care, you'll work within a supportive environment that values your contributions. Join a team committed to transforming healthcare and making a real difference in the lives of millions. Enjoy the flexibility of working from home while being part of a compassionate and purpose-driven organization. This is your chance to thrive in a role that balances professional growth and personal well-being.

Benefits

Affordable Medical Plan Options

401(k) Plan with Company Matching

Employee Stock Purchase Plan

Wellness Screenings

Tobacco Cessation Programs

Weight Management Programs

Confidential Counseling

Financial Coaching

Flexible Work Schedules

Tuition Assistance

Qualifications

• Active RN licensure required with 3+ years of clinical experience.
• Proficiency with computer systems and ability to work under pressure.

Responsibilities

• Review clinical information for precertification and authorization.
• Work primarily at a desk and on the phone, collecting data from providers.

Skills

Critical Thinking

Clinical Experience

Computer Skills

Ability to Work in Fast-Paced Environment

Education

Associates Degree

BSN

Tools

Clinical Practice Guidelines

Job description

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.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Applicants can live anywhere in Eastern Standard Time Zone

This role is Telework anywhere! Preference for WV residents or out of state residents that have the WV licensure and compact licensure.

Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification. The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.

Sedentary work involves periods of sitting, talking, listening and computer use.

Required Qualifications

• Must have active, current and unrestricted RN licensure in state of residence.
• 3+ years of clinical experience.
• Must be willing and able to work Monday - Friday 8 am - 5 pm with occasional weekend/holiday on-call.
• Position requires proficiency with computer skills which includes navigating multiple systems.
• Ability to work in a fast-paced environment.

Preferred Qualifications

• Previous prior authorization experience.
• West Virginia resident preferred.
• Compact RN licensure preferred.

Education

• Associates degree required.
• BSN preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $26.01 - $56.14. 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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

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: 04/05/2025.

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