Prior Authorization Nurse Consultant - Utilization ...

Job DescriptionFully remote position- open to candidates with LA RN license, RN Multi-state compact license and live in state of license. Work 4 /10-hr Shifts Sat/Sun, and 2 days during week. Hours: 7a-6p (Central)Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits. Develops, implements and supports health strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.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 Qualifications- RN with current unrestricted state licensure- 3+ years of clinical experience- 3+ years Managed care, utilization review, and/or prior authorization experience- Must have ability to work 4 /10-hr Shifts Sat/Sun, and 2 days during week. Hours: 7a-6p (Central)Preferred Qualifications3+ years MCO, Managed Care experience Clinical precertification experienceHome health care experienceEducation- Associate's degree required- BSN preferred- RN with current unrestricted state licensure requiredBusiness 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