Utilization Management Nurse Consultant - Remot...
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
This is a fully remote position open to applicants residing in the Eastern Standard Time Zone. Preference is given to West Virginia residents or out-of-state candidates who hold West Virginia RN licensure and compact licensure.
The role involves applying critical thinking, evidence-based clinical criteria, and clinical practice guidelines to review and authorize services requiring precertification. Most of the work is conducted via phone and computer, gathering and evaluating clinical information from providers. Nurses in this role determine service authorization or escalate cases to a Medical Director when necessary.
This is a sedentary role, requiring extended periods of sitting, listening, speaking, and computer use.
Required Qualifications
- Active, unrestricted Registered Nurse (RN) license in state of residence
- Minimum of 3 years of clinical experience
- Availability to work Monday–Friday, 8 AM–5 PM, with occasional weekend/holiday on-call (differential pay for weekend/holiday shifts)
- Proficiency in navigating multiple computer systems
- Ability to thrive in a fast-paced environment
Preferred Qualifications
- Prior experience in precertification or prior authorization
- West Virginia residency preferred
- Compact RN licensure preferred
- Bachelor of Science in Nursing (BSN) preferred
Education
- Associate’s degree in Nursing required
- BSN preferred
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.