Job Description

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 Utilization Management (UM) Nurse Consultant role is 100% work at home and the candidate can live in any state. **Work At Home Requirements:** + Candidate will work from home (WAH) out of their residence. + Have reliable phone and hard-wired internet service. + Work schedules are determined by the Leader based on business needs and are not affected by the work model or location. **Mon - Fri 8:30-5:00 PM in your time zone. Shift times may vary per business need as well as there being a Rotational late shift 9:30-6:00 PM CST time zone.** + Colleagues must be reachable via phone, videoconference, and email during work hours (8 Hours per Day) as directed by their Leader. + Personal responsibilities, including dependent care, must not interfere with work duties. Dependent care during work hours is generally not allowed. + Be secure and private to maintain confidentiality (HIPAA compliant). + Meet any additional reasonable requirements set by the Leader or Company. + Sedentary position must be able to sit for long periods of time. + As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): + Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member. + Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members + Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care + Communicates with providers and other parties to facilitate care/treatment + Identifies members for referral opportunities to integrate with other products, services and/or programs + Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. **Required Qualifications:** + RN with active and unrestricted state licensure in their state of residence + 2 or more years of acute hospital clinical experience as an RN with preference for medical-surgical and ICU experience **Technical Skills Required:** + Proficient in Multisystem Navigation: Comfortable using multiple monitors and systems simultaneously to streamline tasks and improve efficiency. + Effective Multitasker: Skilled at talking and typing concurrently while managing various responsibilities with focus and accuracy. + Basic Technical Troubleshooting: Able to set up and connect essential hardware (monitors, keyboards, etc.) and resolve common technical issues independently. + Digital Collaboration & Documentation: Experienced in electronic documentation and virtual collaboration tools to support remote teamwork and communication. + Highly Organized & Results-Oriented: Maintains a structured approach to work, ensuring tasks are completed on time and in alignment with performance metrics. + Metric-Driven Performance: Demonstrates accountability by consistently meeting or exceeding established goals and expectations. **Preferred Qualifications:** + 1 or more years' experience Utilization Review experience + 1 or more years' experience Managed Care + Strong telephonic communication skills + 1 or more years' experience with Microsoft Office Suite (PowerPoint, Word, Excel, Outlook) + Ability to exercise independent and sound judgment, strong decision-making skills, and well-developed interpersonal skills + Ability to manage multiple priorities, effective organizational and time management skills required **Education Requirements:** + Associate Degree in Nursing is minimum required, BSN preferred. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **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. For more information, visit We anticipate the application window for this opening will close on: 12/05/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Job Tags

Hourly pay, Full time, Temporary work, Live in, Work at office, Local area, Remote work, Flexible hours, Shift work, Afternoon shift,

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