Utilization Management Nurse Consultant

CVS Health • Columbus, OH • 2h ago

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Multiple shifts available with start times varying from 8:00am - 11:30am EST.

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. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team.

Key Responsibilities

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.

Thrive in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills.

Perform sedentary work that primarily involves extended periods of sitting, as well as frequent talking, listening, and use of a computer.

Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring continuity of care and operational support.

Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.

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.

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

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

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $74.78

This 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.

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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. 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.

Go to Apply

Supervisory Medical Support Assistant

Veterans Affairs, Veterans Health Administration • Columbus, OH • 1d ago

Hospital & Medical

Summary The incumbent serves as a Medical Support Assistant in the Specialty Care section of the Patient Business Office. This position serves the VA Ambulatory Care Center in Columbus Ohio. They will be assigned to work...

1d ago

Go to Apply

Medical Assistant

OhioHealth • Grove City, OH • 1d ago

Hospital & Medical

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further...

1d ago

Go to Apply

Physical Therapist Assistant

Amedisys Holding, LLC • Powell, OH • 1d ago

Hospital & Medical

Overview Full time Day Visits Focus Area: Entire area. Main focus will be on the west side to start Are you looking for a rewarding career in homecare? If so, we invite you to join our team at Amedisys, one of the larges...

1d ago

Go to Apply

Physical Therapist

OhioHealth • Pickerington, OH • 2d ago

Hospital & Medical

2d ago

Go to Apply

Abbott Nutrition Consumer Sales Internship Summer 2026

Abbott • Columbus, OH • 2d ago

Hospital & Medical

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnost...

2d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.