Utilization Management Nurse Consultant

Job Description
This is a fully remote position open to licensed Registered Nurses residing anywhere within the United States.

Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for surgical services requiring precertification.

The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers.

Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.

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 position

Required Qualifications
3+ years of experience as a Registered Nurse (RN) with current unrestricted license in state of residence
3+ years of clinical experience

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
Clinical precertification experience
Managed care/utilization review experience
Case Management experience
Ambulatory surgery center experience

Nursing diploma or Associate's degree acceptable
BSN preferred

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.