UM Nurse Consultant – Specialty UM, Spine

Job not on LinkedIn

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Review prior authorization requests for spine-related procedures and services • Apply evidence-based criteria, including MCG guidelines and clinical policies • Assess clinical records, treatment plans, and provider documentation • Collaborate with providers, Medical Directors, and health plan teams • Support appropriate care decisions and timely, accurate coverage determinations • Ensure compliance with regulatory and organizational requirements • Meet quality, productivity, and turnaround-time standards • Contribute to process improvements • Provide rotating weekend and holiday coverage

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license in state of residence • Willingness to obtain additional state licensure as needed • 3-5+ years of clinical nursing experience • Strong knowledge of medical necessity review and evidence-based practice • Excellent critical thinking, communication, and documentation skills • Associate Degree in Nursing (ASN) required • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 25 Mbps download and 3 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Must provide own workspace furniture • Comfortable using multiple monitors and multiple applications simultaneously • Ability to use email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 or similar applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer, password, and information-security practices • Ability to troubleshoot common technical issues independently • Openness to learning new skills as the workplace evolves

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program eligibility • Company-provided equipment (keyboard, monitor, computer, headset, etc.)