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CVS Health Utilization Management Nurse Consultant in New Albany, Ohio

Job Description

This position will be working from home anywhere. Schedule is Monday - Friday 8am-5pm based on employee's time zone. No travel.Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases.Applies the appropriate clinical criteria/guideline to render a medical determination to the client. Identifies opportunities to promote qualityeffectiveness.Consults and lends expertise to other internal and external constituents.Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review 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 environment.

Required Qualifications

3+ Years of clinical experience. 2 Years of Microsoft office experience.1 Year of Utilization Review Management and/or Medical Management experience.Must have active and unrestricted RN license in the state you reside.

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications

1+ Years of Medical Management experience.


BSN preferred, ADN required.

Business Overview

Bring 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.