Utilization Management Nurse Consultant

We’re building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Are you an experienced Registered Nurse looking to expand your impact beyond direct patient care? Join our Utilization Management team and use your clinical expertise to help ensure members receive appropriate, high-quality, and cost-effective healthcare services.

• Review clinical information and apply evidence-based guidelines, policies, and clinical judgment to support coverage determinations
• Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
• Collaborate with providers and care teams to facilitate appropriate treatment and care planning
• Identify opportunities to improve quality of care, member outcomes, and healthcare utilization
• Connect members with additional programs, services, and resources when appropriate
• Serve as a clinical resource for internal and external stakeholders

• Active, unrestricted RN license in your state of residence
• 2+ years of adult acute care and/or critical care nursing experience
• Strong clinical assessment, critical thinking, and communication skills
• Ability to multitask and work effectively in a fast-paced environment
• Proficiency navigating multiple computer systems and applications
• Associate Degree in Nursing required

• 2+ years of Med-Surg or specialty nursing experience
• Managed Care or Utilization Management experience
• Residence in the Central Time Zone preferred
• BSN preferred

• Utilization Management operates 24/7
• Schedules may include evenings, weekends, and holidays
• Remote, computer-based role with productivity and quality expectations
• Frequent collaboration with providers, members, and interdisciplinary healthcare teams

• Apply your clinical expertise in a rewarding non-bedside role
• Make a meaningful impact on healthcare quality and member outcomes
• Work remotely as part of a collaborative clinical team
• Grow your career in Utilization Management and Managed Care

• 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.

• 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…