UM Nurse Consultant – Specialty UM, Spine

Job not on LinkedIn

🕒 August 27

🤠 Texas – Remote

🤠 Texas – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 24%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 to support appropriate care decisions • Ensure compliance with regulatory and organizational requirements • Meet quality, productivity, and turnaround time standards • Contribute to process improvements • Provide timely, accurate coverage determinations for spine-related authorization requests • Work Monday-Friday, 8:00 AM-5:00 PM EST/CST, with 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 • Experience in orthopedics, spine surgery, neurosurgery, pain management, rehabilitation, or utilization management preferred • Managed care, health plan, or payer experience preferred • Knowledge of Medicaid programs and authorization requirements preferred • Experience with MCG, Clinical Policy Bulletins, MedCompass, QNXT, or similar UM platforms preferred • Eastern or Central Time Zone preferred • 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 virtual work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Comfortable setting up and using multiple monitors and navigating multiple applications • Ability to use digital communication channels including email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to maintain strong passwords and recognize suspicious emails or links • Ability to resolve common technical issues independently • Openness to learning new skills as the workplace evolves

🏖️ Benefits

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