UM Nurse Consultant

Job DescriptionThis 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-4:30 pm in the time zone of residence with a rotation until 6:30pm EST. 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 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 licensure in the state that you reside. - 2+ years of recent acute hospital clinical experience as an RN required (recent defined as in the past 10 years).COVID 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- Experience with all types of Microsoft Office including PowerPoint, Excel, and Word preferred.- Utilization Review experience preferred.- Managed Care background preferred.- Strong telephonic communication skills preferred.Education- Associate's Degree in Nursing with RN licensure required. 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: 2025-11-15