Utilization Management Nurse Consultant

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare)Remote | Full-Time | Weekday ScheduleAre you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time.What You'll DoReview clinical cases and make coverage determinations using evidence-based guidelinesCollaborate with providers and care teams to coordinate appropriate treatmentApply clinical judgment to support utilization and benefit management decisionsIdentify opportunities to improve care quality and member outcomesServe as a clinical resource across internal and external stakeholdersWhat You Bring - REQUIREDActive, unrestricted RN license in the state of residence.3+ years of RN experience, including 1+ year in Med/SurgStrong clinical assessment and decision-making skillsExperience with Microsoft Office (Outlook, Teams, Excel)Ability to work Monday–Friday, 9:00 AM–6:00 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hoursAssociate Degree in NursingNice to HaveUtilization Management or Prior Authorization experienceManaged care backgroundFamiliarity with MedCompassAmbulatory surgery experienceBSN preferredWhy Join Us?Transition your clinical skills into a collaborative, non-bedside roleMake a meaningful impact on patient care and outcomesWork in a supportive, team-driven environmentIf you're passionate about combining clinical expertise with care coordination and healthcare quality, we'd love to hear from you!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 evolves.Anticipated Weekly Hours: 40Time Type: Full timePay Range: The typical pay range for this role is: $29.10 - $62.32. 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.