UM Nurse Consultant

Job DescriptionWorking hours will be Monday-Friday 8AM-4:30PM - Ability to work between 8am-6pm EST, with Friday rotation up to 9pm. EST.Weekends and holidays will be required per the needs of the department. Travel may be required for plan meetings. Candidates can apply from any state. The UMNC role entails the nurse to utilize clinical judgment along with criteria/guidelines to ensure the member is in the appropriate setting- The inpatient care process includes obtaining necessary information from providers and facilities concerning the care being provided to members. Completing assessments of a member's clinical condition and ongoing medical services and treatments to determine medical appropriateness- 90% of the day is spent utilizing clinical judgment along with criteria to ensure the member is in the appropriate setting- Guide the setting for medical intervention to achieve optimum length of stay for members- Early identification of continuing care needs to facilitate discharge to the appropriate setting and discharge planning - Collaborate with other team members to ensure the member's discharge plan is met and discuss other issues or needsRequired Qualifications-RN licensure required- 3+ years of clinical experience required- 3+ years of Medical-Surgical Care-1+ year of Discharge Planning-1+ year of Concurrent ReviewCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications-Managed Care experience preferred-Utilization review experience preferred -Maximizing Healthcare Quality experience preferred -Turning Data into Information experience preferred -Experience collaborating for Results- Excellent verbal and written communication skills - Strong computer skills (Microsoft Outlook, Word, Window Systems)-Experience interacting with Medical Professionals-Experience supporting Medical Practice-Experience applying Reasoned JudgmentEducationAssociate's degree required, Bachelor's degree preferredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.

Created: 2025-11-15