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Utilization Management Nurse Consultant – Specialty Medications
CVS HealthNurse Consultant at CVS Health reviewing inpatient and outpatient services, collaborating with providers and maintaining documentation. Responsible for clinical reviews and authorized care in a remote setting.
About the role
Key responsibilities & impact- Apply clinical judgment and evidence-based criteria to review inpatient and outpatient services.
- Collaborate with providers and authorize care while maintaining accurate documentation.
- Participate in occasional on-call rotations, including some weekends and holidays.
- Conduct clinical reviews via phone and collaborate with healthcare providers to gather necessary information.
- Navigate multiple computer systems efficiently while maintaining documentation accuracy.
- Flexibly provide coverage for other Utilization Management Nurses as needed.
Requirements
What you’ll need- Active unrestricted state Registered Nurse licensure in state of residence required.
- 1+ year of prior authorization of injectable/infused specialty medication experience.
- Minimum 5 years of relevant experience in Nursing.
- At least 1 year of Utilization Management experience in concurrent review or prior authorization.
- Strong decision-making skills and clinical judgment in independent scenarios.
- Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms.
- Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation.
Benefits
Comp & perks- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical judgmentevidence-based criteriaprior authorizationinjectable medication experienceinfused medication experienceUtilization Managementconcurrent reviewclinical documentation
Soft Skills
decision-makingindependent judgmentcollaborationflexibility
Certifications
Registered Nurse licensure