We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Regular business hours are 8:00 am-8:00 pm EST.
Work hours: 8 hour shifts available with start times between 8:00am - 11:30am EST.
About Us
American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members.
Position Summary
Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to review inpatient and outpatient services. You'll collaborate with providers, authorize care, and escalate cases when needed, all while navigating multiple systems and maintaining accurate documentation. This role suits nurses who thrive in fast-paced environments, are highly organized, and comfortable with computer-based work.
Key Responsibilities
Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.
Perform sedentary work that primarily involves extended periods of sitting, as well as frequent talking, listening, and use of a computer.
Thrive in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills.
Apply critical thinking and evidence-based clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review.
Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information.
Use established guidelines to authorize services or escalate to Medical Directors as needed.
Navigate multiple computer systems efficiently while maintaining accurate documentation.
Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring continuity of care and operational support.
Remote Work Expectations
This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
Required Qualifications
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.
Preferred Qualifications
Experience with NCCN criteria preferred.
1+ year of experience in a managed care organization (MCO).
Experience in a high-volume clinical call center or prior remote work environment.
Education
Associate's degree in nursing (RN) required, BSN preferred.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$29.10 - $62.32This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Active unrestricted state Registered Nurse licensure in state of residence
- 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 with 100% participation
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
-
Healthcare Strength — Healthcare coverage is positioned as comprehensive for benefits-eligible colleagues, including medical, dental, and vision with free preventive care and access to virtual care and select no-cost MinuteClinic services. Mental health support is also highlighted with no-cost confidential counseling sessions per issue.
-
Retirement Support — Retirement benefits include a 401(k) with a dollar-for-dollar match up to 5% after meeting service and hours requirements. Ownership programs are also offered through an employee stock purchase plan with a stated purchase discount.
-
Pay Growth & Progression — A companywide minimum wage floor establishes a baseline that is framed as a positive starting point in some roles and markets. Unionized or high-cost areas are described as having clearer wage scales and step-ups that can materially lift pay over time.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
.png){kind=logo}
