Utilization Management Nurse Consultant

Utilization Management Nurse Consultant (RN) - RemoteMust Reside in Oklahoma. Join a collaborative team dedicated to helping members receive the right care, at the right time, in the right setting.As a Utilization Management Nurse Consultant, you will use your clinical expertise to review medical necessity, coordinate care, support discharge planning, and make informed coverage recommendations. You'll work closely with providers, facilities, and internal partners to ensure quality outcomes while meeting regulatory requirements.Schedule100% Remote (Oklahoma based)Monday-Friday, generally 8:00 AM-5:00 PM CSTNo travel requiredOccasional Weekend on callWhat You'll DoReview clinical information and authorize services based on established criteria and guidelinesAssess medical necessity and appropriate benefit utilizationCoordinate care and support safe, efficient discharge planningCommunicate with providers and healthcare teams to facilitate treatment plansIdentify opportunities for care management and quality improvementDocument and manage utilization review activities throughout the continuum of careRequired QualificationsActive, unrestricted RN license in OklahomaMinimum 2 years of acute care hospital RN experienceAssociate Degree in Nursing (BSN preferred)Preferred QualificationsUtilization Review and/or Utilization Management experienceManaged Care experienceStrong communication and critical-thinking skillsProficiency with Microsoft Office and computer-based systemsAbility to effectively manage multiple priorities in a fast-paced environmentIf you're a clinically strong RN looking to leverage your expertise in a remote role focused on improving patient outcomes and healthcare quality, we'd love to hear from you. Apply today!Work from Home Requirements:You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.Technical and Logistical Requirements:Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.Future Growth: Openness to learning new skills in the future as the workplace environment evolvesAnticipated Weekly Hours: 40Time Type: Full timePay 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.Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.