CVS Health is an American healthcare company working across healthcare services, health insurance, pharmacy benefits management, and retail pharmacy. Through businesses including Aetna and CVS Caremark, it supports health coverage, prescription access, condition management, specialty medications, and mail-order pharmacy services. Its neighborhood pharmacies and broader care offerings are designed to help people access essential healthcare more conveniently and affordably. CVS Health brings together insurance, pharmacy, and health services to support individuals and communities throughout their care journeys.
Remote Utilization Management Nurse Consultant at CVS Health
Review Medicare cases and make evidence-based coverage decisions as a remote Utilization Management Nurse Consultant at CVS Health. Help improve care quality and member outcomes through clinical collaboration and care coordination.
Description
- Assess clinical cases and determine coverage using evidence-based guidelines.
- Work with providers and care teams to coordinate appropriate treatment.
- Use clinical judgment to guide utilization and benefit management decisions.
- Find ways to improve care quality and member outcomes.
- Provide clinical guidance to internal and external stakeholders.
- Apply clinical expertise in a collaborative role outside bedside care.
- Support member care coordination and healthcare quality.
Requirements
- Hold an active, unrestricted RN license in your state of residence.
- Have at least three years of RN experience, including at least one year in medical-surgical nursing.
- Bring strong clinical assessment and decision-making skills.
- Have experience using Microsoft Office, including Outlook, Teams, and Excel.
- Be available Monday through Friday, 9:00 a.m. to 6:00 p.m. in your time zone; schedules may include holidays and evening hours.
- Have an Associate Degree in Nursing.
- Use a direct, hardwired internet connection located within seven feet of the modem or router.
- Have internet service with at least 25 Mbps download and 3 Mbps upload speeds.
- Do not use Wi-Fi or satellite internet service.
- Maintain a quiet, secure, private home workspace that meets CVS Health and HIPAA guidelines.
- Work from the state and city where you currently reside.
- Be able to use multiple monitors and applications at the same time.
- Be comfortable using digital communication channels and virtual meetings.
- Have experience with Microsoft Office 365 or similar Google Workspace applications.
- Be able to access secure systems such as VPN and EHR portals.
- Follow computer and password security practices and identify suspicious emails or links.
- Be able to resolve common technical issues independently.
- Be open to learning new skills.
- A BSN is preferred.
Benefits
- Eligibility for CVS Health bonus, commission, or short-term incentive programs in addition to base pay.
- Medical, dental, and vision coverage.
- Paid time off.
- Retirement savings options.
- Wellness programs.
- Resources supporting physical, emotional, and financial well-being.
- Company-provided equipment, including a keyboard, monitor, computer, and headset.