UM Nurse Consultant - Remote Full-Time Position with CVS Health - Utilization Management and Healthcare Benefits Coordination

Join the CVS Health Team as a UM Nurse Consultant - Remote CVS Health is a leading healthcare company that is dedicated to delivering enhanced human-centric healthcare for a rapidly changing world. We are seeking a highly skilled and compassionate UM Nurse Consultant to join our team on a remote basis. As a UM Nurse Consultant, you will play a critical role in assessing, planning, implementing, coordinating, monitoring, and evaluating healthcare services and benefits for our members. About CVS Health At CVS Health, we are driven by a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to delivering high-quality, patient-centered care that is accessible, affordable, and convenient. Our Heart At Work Behaviors support this purpose, empowering every employee to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make healthcare more personal, convenient, and affordable. Position Summary As a UM Nurse Consultant, you will utilize your clinical experience and skills to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for our members. Your primary responsibilities will include: Conducting comprehensive reviews of clinical information to determine coverage determinations and recommendations along the continuum of care Communicating with providers and other parties to facilitate care and treatment Identifying members for referral opportunities to integrate with other products, services, and programs Identifying opportunities to promote quality and effectiveness of healthcare services and benefit utilization Consulting and lending expertise to other internal and external constituents in the coordination and administration of utilization and benefit management functions Key Responsibilities As a UM Nurse Consultant, your key responsibilities will include: Utilizing 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 Gathering clinical information and applying the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care Communicating with providers and other parties to facilitate care/treatment Identifying members for referral opportunities to integrate with other products, services, and/or programs Identifying opportunities to promote quality effectiveness of healthcare services and benefit utilization Consulting and lending expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function Requirements and Qualifications To be successful as a UM Nurse Consultant, you will need: Essential Qualifications: 3+ years of experience as a Registered Nurse 3+ years of clinical experience required Active current and unrestricted RN licensure in the state of residence 1+ years of clinical experience in an acute or post-acute setting Availability to work Monday through Friday from 8 AM to 5 PM in your resident time zone, with some weekends and holidays required Preferred Qualifications: Managed Care experience preferred BSN degree preferred Education and Skills We are looking for candidates with: Associate's degree required; BSN degree preferred Proficiency with computer skills, including navigating multiple systems and keyboarding Effective communication skills, both verbal and written Work Environment and Culture As a remote UM Nurse Consultant, you will work in a dynamic and supportive environment that values flexibility and work-life balance. Our company culture is built on the principles of respect, integrity, and compassion, and we are committed to providing a workplace that is inclusive, diverse, and engaging.

Compensation and Benefits

We offer a competitive salary and benefits package, including: A competitive salary range of $29.10 - $62.31 per hour, depending on experience and qualifications A comprehensive benefits package, including medical, dental, and vision coverage A 401(k) retirement savings plan and Employee Stock Purchase Plan Fully-paid term life insurance and short-term and long-term disability benefits Paid Time Off (PTO) and paid holidays Opportunities for professional development and education assistance Career Growth and Learning Benefits At CVS Health, we are committed to supporting the career growth and development of our employees. As a UM Nurse Consultant, you will have access to: Training and development programs to enhance your clinical and professional skills Opportunities for advancement and career progression A supportive and collaborative work environment that encourages learning and growth Why Join CVS Health? By joining CVS Health as a UM Nurse Consultant, you will be part of a team that is dedicated to making a positive impact on the lives of our members and the communities we serve. You will have the opportunity to: Make a meaningful difference in the lives of our members Work with a talented and dedicated team of healthcare professionals Develop your skills and expertise in a dynamic and supportive environment Enjoy a competitive salary and benefits package How to Apply If you are a motivated and compassionate RN looking for a challenging and rewarding role, we encourage you to apply for this exciting opportunity. Please click the Apply Now button to submit your application. We look forward to hearing from you and exploring how you can join our team as a UM Nurse Consultant - Remote. Apply for this job Apply tot his job Apply tot his job Apply To this Job