UM Prior Authorization Nurse Consultant

Job DescriptionThis position will be working from home anywhere. They must have an active unrestricted NJ RN licensure or compact licensure.Schedule is either: Thursday-Sunday (10 hour days), Friday-Monday (10 hour days) or Saturday-Tuesday (10 hour days). There is a 12.5% shift differential for this schedule. Holidays will be rotated 1-2 times per year. No travel will be required. Position Summary:Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for medical/surgical services requiring precertification. The majority of the time is spent at a desk and on the telephone collecting & reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.Sedentary work involves periods of sitting, talking, listening and use of the computer.Ability to work in a fast paced environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboarding.Pay 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 experience1+ years of experience with Managed care/utilization review/prior authorization experienceMust possess active, unrestricted New Jersey RN licensure OR compact licensureMust have the ability to work a Thursday-Sunday (10 hour days), Friday-Monday (10 hour days) or Saturday-Tuesday (10 hour days) schedule. There is a 12.5% shift differential with this schedule.Preferred Qualifications1+ year Clinical precertification experienceEducationRN NJ License or Compact LicensureBusiness 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