UM Nurse Consultant

Job DescriptionApplies critical thinking, evidenced based clinical criteria and clinical practice guidelines for procedures/services that do not require precertification. The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers. Medicare Predetermination nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.The alternate shift schedule (20/20) will begin six months after the nurse successfully completes the orientation period. During orientation, hours will be 8-5pm M-F with occasional rotation until 8pm. Potential for some on-call holiday and weekend coverage.Pay RangeThe typical pay range for this role is:Minimum: 58,760Maximum: 125,840Please 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- Registered Nurse (RN) with current unrestricted state license- 3+ years of clinical experience- 1+ years of Utilization Management experiencePreferred Qualifications- Clinical precertification/predetermination experience- Managed care/utilization review experience- Case Management experience- Ambulatory surgery center experience- Position requires proficiency with computer skills which includes navigating multiple systems- Ability to work in a fast-paced environment- Must possess or have the ability to obtain high speed internet access as this is a fully remote positionEducationNursing diploma or Associate's degree in nursing acceptableBSN preferredBusiness OverviewBring your heart to CVS Health Every 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-11-15