UM Nurse Consultant

Job DescriptionConcurrent ReviewThis role is work from home with the following hours: Evening shift 3pm-11pm on Fridays, 8AM-5 PM Saturday and Sundays, 2 flexible weekday shifts, with rotating on call holiday coverage required. 4 ten-hour shifts would be considered.Applicants must be a RN with LA or compact licensure required with ability to obtain additional licenses as needed.-Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.-Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function-Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care-Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)-Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment-Identifies members who may benefit from care management programs and facilitates referral-Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilizationPay RangeThe typical pay range for this role is:Minimum: 55,300Maximum: 118,900Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications3+ years of clinical practice experience in an inpatient setting required2+ years of experience as a Registered Nurse with active unrestricted LA or compact state licensure. Must have the ability to obtain additional state licenses as neededMust have the ability to work a schedule with rotating weekend on-call coveragePreferred QualificationsManaged care experienceDischarge planning experienceUtilization Management experiencePediatric OBEducationAssociate degree requiredBSN 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