UM Nurse Consultant

Job DescriptionFully remote position. Working hours will be 8am-7pm CST shift can vary between these hours. Shift details will be provided during interview. Weekends may be required per the needs of the department. Holidays will be on a voluntary basis. No travel will be required. Candidates can apply from any state however must be able to work CST hours. As a UMNC, you will help support the Amazon In Touch Care Dedicated team to provide comprehensive coordination of medical services for the membership. UMNCs utilize clinical skills to coordinate, document andcommunicate all aspects of the utilization/benefitmanagement program. Requires an RN with unrestrictedactive license.This is a work from home UtilizationManagement position. This position involves using acomputer station and may require sitting for extendedperiods of time. Candidates must possess good computerskills. This position is ideal for a Registered Nurse seekinga fast paced environment. The UM Nurse Consultant is anintegral member of the care management team utilizingclinical skills in a collaborative process to assess, plan,implement, coordinate, monitor and evaluate options andservices thereby aiding in facilitating appropriate inpatienthealthcare management and effective discharge planningto improve the outcomes for members. More specifically,the inpatient care process includes: obtaining necessaryinformation from providers and facilities; assessment of amember's clinical condition and ongoing medical servicesand treatments to determine medical appropriateness;guide the setting for medical intervention to achieveoptimum length of stay for members. Authorize andcoordinate the required services, in accordance with thebenefit plan. The UM Nurse Consultant determinesappropriate levels of coverage for inpatient stay usingclinical judgment and application of Milliman CareGuidelines to meet the member's needs. The UM NurseConsultant periodically evaluates the member's progressin meeting the inpatient care plan / discharge goals andrevises and coordinates the plan with the hospitaldischarge planner, the attending physician, and thepatient/family when appropriate. The UMNC assists indeveloping an approach to removing barriers andcollaborates with UR departments to facilitate adherenceto the care plan.Required Qualifications-3+ years of clinical experience required in the acutecare/hospital setting.-RN with current, unrestricted state license requiredCOVID 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-BSN desirable but not required.-Candidate must possess strong customer service skills including: attention to customers & sensitivity to certain issues.-Managed Care experience preferred but not required.EducationAssociate's degree or BSN preferred.Business 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: 2025-11-01