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Position Summary

This Utilization Management Nurse Consultant (UMNC) position is a work at home position (fully remote) and the candidate can live in any state.

Normal Working Hours: Monday through Friday 8:00am-6:00pm in the time zone of residence with an evening rotation per the needs of the team.

In addition, the team is open to candidates in PST and/or MST time zones to provide increased daily coverage until 6:30pm EST (10:00am-6:30pm EST).

There is a weekend (Saturday and Sunday both) and holiday rotation per the needs of the department.

Minimal travel is expected but could be up to 10% in the event of a clinical audit.

As a Utilization 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. Looking for someone who is high energy and motivated team environment and is detail oriented and highly organized.

The UM Nurse Consultant 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.

Required Qualifications

Must have an active and unrestricted RN license in the state of residence
Willing and able to obtain a CA state RN license within 6 months of hire (company paid)
2+ years of recent acute hospital clinical experience as an RN (recent defined as in the past 10 years)

Preferred Qualifications

Compact RN license or the ability to obtain a compact license
Utilization Review experience
Managed Care background
Strong telephonic communication skills
Experience with all types of Microsoft Office including PowerPoint, Excel, and Word

Education

Minimum Associates Degree in Nursing
BSN preferred

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 10/27/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management Nurse Consultant

CVS Pharmacy

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