Utilization Management Nurse Consultant (Work From Home)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time. This is an exciting new role supporting home care requests for Florida Medicare members.

• →Review clinical cases and make coverage determinations using evidence-based guidelines
• →Collaborate with home care providers, attending MDs and care teams to coordinate a smooth transition of care from a hospital and/or post-acute setting to home care
• →Apply clinical judgment to support utilization and benefit management decisions
• →Identify opportunities to improve care quality and member outcomes
• →Serve as a clinical resource across internal and external stakeholders

• Active, unrestricted RN license in the state of residence.
• 2+ years of RN experience, including 1+ year in Med/Surg
• Strong clinical assessment and decision-making skills
• Experience with Microsoft Office (Outlook, Teams, Excel)
• Ability to work Monday–Friday, 9:00 AM–6:00 PM in your time zone.   Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
• Associate Degree in Nursing

• Utilization Management or Prior Authorization experience
• Managed care background
• Home health experience
• BSN preferred

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.