# UM Nurse Consultant

**Company**: CVS Health
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $26.01 - $68.55
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/NJ---Work-from-home/Utilization-Management-Nurse-Consultant_R1073491?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/um-nurse-consultant-72b6eaf5-145/

## Description

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Utilization Management (UM) Nurse Consultant utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

**Responsibilities**

- Gather clinical information and apply clinical criteria/guidelines, policies, procedures and clinical judgment to render coverage determinations/recommendations along the continuum of care.

- Communicate with providers and other parties to facilitate care/treatment.

- Identify members for referral opportunities to integrate with other products, services and/or programs.

- Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.

- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

**Requirements**

- 3-5 years of Med/Surg experience.

- 3+ years of experience as an RN.

- 1+ year of inpatient hospital experience.

- Active, current, and unrestricted RN licensure in state of residence.

- Ability to work in multiple IT platforms/systems.

- 1+ year of experience with Microsoft Office applications (Outlook, Teams, Excel).

**Preferred Qualifications**

- Experience with Medicare/Medicaid populations.

- MCG experience.

- Managed care experience.

- UM Certification.

- MedCompass experience.

- 1+ year of inpatient utilization experience.

**Education**

- Associate's degree required.

- BSN preferred.

**Work from Home Requirements**

- Direct/hardwired internet connection to a modem/router within 7 feet of computer.

- Minimum download speed of 25 mbs and upload speed of 3 mbs.

- Quiet, secure and private designated home virtual work location.

**Technical and Logistical Requirements**

- Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.

- Ability to communicate on digital channels such as email, calendar invites, Teams messaging, and virtual meetings.

- Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar.

- Ability to log in to secure systems, manage strong passwords, and recognize suspicious emails or links.

- Ability to resolve common technical issues independently.

**Benefits**

- Comprehensive benefits package including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.

**Anticipated Weekly Hours**

- 40 hours per week.

**Time Type**

- Full-time.

**Pay Range**

- $26.01 - $68.55 per hour.

For more fresh new jobs, check out [yubhub.co](https://yubhub.co/).

## Skills

### Required
- RN licensure
- Microsoft Office
- clinical experience
- utilization management

### Nice to have
- Medicare/Medicaid
- MCG
- managed care
- UM Certification
- MedCompass

---

Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/NJ---Work-from-home/Utilization-Management-Nurse-Consultant_R1073491?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)