Utilization Management Nurse Consultant; Work From Home

The Utilization Management Nurse Consultant role at CVS Health is designed for Registered Nurses looking to leverage their clinical expertise in a non-bedside position. This remote position focuses on supporting home care requests for Florida Medicare members.

• Pay: $29.10 - $62.32/hour
• Location: Remote, FL
• Schedule: Full-time, Weekday Schedule

• Review clinical cases and make coverage determinations using evidence-based guidelines.
• Collaborate with home care providers, attending MDs, and care teams to coordinate transitions of care.
• 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.

• Education:
  • Associate Degree in Nursing required, BSN preferred.
• Experience:
  • 2+ years of RN experience, including 1+ year in Med/Surg.
  • Utilization Management or Prior Authorization experience preferred.
  • Managed care background preferred.
  • Home health experience preferred.
• Licenses &
  
  Certifications:
  
  
  • Active, unrestricted RN license in the state of residence required.

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They prioritize safety and quality in everything they do, aiming to simplify healthcare for individuals and communities.