Join CVS Health and apply your clinical expertise to make a difference for members navigating complex oncology and transplant journeys. As a fully remote Utilization Management Nurse Consultant, you'll conduct clinical reviews to ensure timely, medically necessary care, working from a desk-based environment that demands precision and compassion.
What You'll Do
- Conduct medical necessity reviews for oncology and transplant-related inpatient and outpatient services.
- Collaborate with healthcare providers via phone and electronic systems to gather and assess clinical documentation.
- Apply evidence-based clinical criteria and guidelines to authorize services or refer cases to Medical Directors.
- Navigate multiple computer systems efficiently while maintaining accurate and timely documentation.
- Work in a primarily sedentary setting involving extended periods of sitting, talking, listening, and computer use.
- Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.
What We're Looking For
- Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges and ability to obtain licensure in non-compact states as needed.
- Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review, or prior authorization.
- 3+ years of experience in Acute clinical Oncology or Oncology/Transplant.
- 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.
Nice to Have
- 1+ years of Managed Care (MCO) experience.
- 1+ years of experience working in a high-volume clinical call center environment.
- NCCN (National Comprehensive Cancer Network) guideline experience/exposure.
- Remote work experience.
Benefits & Compensation
- Compensation: $29.10 - $62.32 per hour.
- Affordable medical plan options, a 401(k) plan with matching company contributions, and an employee stock purchase plan.
- No-cost programs including wellness screenings, tobacco cessation, weight management, confidential counseling and financial coaching.
- Benefit solutions addressing diverse needs including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, and retiree medical access.
Work Mode
This is a fully remote position. Candidates must be located within the United States.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
