Utilization Management Nurse Consultant - New Jersey Registered Nurse License Required

CVS Health; Trenton (NJ); Remote; Full time

Job summary

A leading health solutions company is seeking a Utilization Management Nurse Consultant. This fully remote role requires a New Jersey RN license and involves critical thinking and clinical criteria application for precertification services. Candidates should have clinical experience and be comfortable working in a 24/7 operation.

Benefits

Affordable medical plan options

401(k) plan with company matching

Employee stock purchase plan

Wellness screenings

Confidential counseling

Tuition assistance

Qualifications

• 3+ years of clinical experience.
• 2+ years experience using personal computer and MS Office applications.

Responsibilities

• Collect and review clinical information from providers.
• Authorize procedures/services or initiate Medical Director referral.

Skills

Critical Thinking

Clinical Practice Guidelines

MS Office Suite

Education

Associates Degree

BSN

Job description

Utilization Management Nurse Consultant - New Jersey Registered Nurse License Required

Utilization Management Nurse Consultant - New Jersey Registered Nurse License Required

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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

Fully remote role

Must be able to work an Eastern Standard Time schedule

Must be a licensed Registered Nurse, any compact licensure must cover New Jersey

• Utilization Management is a 24/7 operation and the work schedule may include weekends, holidays, and evening hours.
• 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.
  
  

Required Qualifications

• Must have active, current and unrestricted RN licensure in New Jersey or Compact RN License
• 3+ years of clinical experience
• Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
• 2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
  
  

Preferred Qualifications

• Previous prior authorization experience
• Prior experience working for a health plan
  
  

Education

• Associates degree required
• BSN preferred
  
  

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$34.92 - $74.78

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: 05/19/2025

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

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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