Utilization Management Nurse Consultant

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🔥 0 minutes ago

🌵 Arizona, Idaho, +3 more states – Remote

🌵 Arizona – Remote 🥔 Idaho – Remote 🌲 Oregon – Remote 🎸 Mississippi – Remote 🤠 Texas – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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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 clinical cases and make coverage determinations using evidence-based guidelines • Collaborate with providers and care teams to coordinate appropriate treatment • Apply clinical judgment to support utilization and benefit management decisions • Identify opportunities to improve care quality and member outcomes • Serve as a clinical resource across internal and external stakeholders • Transition clinical skills into a collaborative, non-bedside role • Support care coordination and healthcare quality

🎯 Requirements

• Active, unrestricted RN license in the state of residence • 3+ years of RN experience, including 1+ year in Med/Surg • Strong clinical assessment and decision-making skills • Experience with Microsoft Office, including Outlook, Teams, and Excel • Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone • Work schedules include holidays and evening hours because Utilization Management is a 24/7 operation • Associate Degree in Nursing • Utilization Management or Prior Authorization experience (nice to have) • Managed care background (nice to have) • Familiarity with MedCompass (nice to have) • Ambulatory surgery experience (nice to have) • BSN preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to the base pay range • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Comprehensive benefits package for eligible full-time colleagues and their families