[Hiring] Utilization Management Nurse Consultant @CVS Health

Role Description

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.

Qualifications

• 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.

Requirements

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

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.