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Utilization Management Nurse Consultant - Medical Review (Remote)

$26.01 - $56.14 / hour

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. Position Information Schedule: Monday–Friday 8:00am-5:00pm EST Location: 100% Remote (U.S. only) 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 a team that’s making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers the opportunity to apply your clinical expertise in a fast-paced, desk-based environment where precision, communication, and compassion intersect. Key Responsibilities Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. Applies the appropriate clinical criteria/guideline and plan language or policy specifics to render a medical determination to the client. Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring and feedback. Actively cross-trains to perform reviews of multiple case types to provide a flexible workforce to meet client needs. Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and client satisfaction. Must be able to work independently without personal distractions to meet quality and metric expectations. 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 RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed. Minimum 3 years of clinical experience. 5 years demonstrated to make thorough independent decisions using clinical judgement. 5 Years proficient use of equipment experience including phone, computer, etc. and clinical documentation systems. 1+ Year of Utilization Review Management and/or Medical Management experience. Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation. Preferred Qualifications Experience with interpreting Plan Language, Policies, and Benefits to determine medical necessity. MCG Milliman, CPB or other criteria guideline application experience is preferred. Education Associate's degree in nursing (RN) required, BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $56.14 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. 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 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 We anticipate the application window for this opening will close on: 03/28/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

NP

Part-time

1 week ago

Advanced Practice Provider FNP/PA

CVS Health Columbia, SC

$37.66 - $81.11 / hour

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. This is a Part-Time float role base out of Columbia, SC and covering clinics in Columbia, Irmo and Lexington. A Brief Overview As the largest retail health care provider in the nation and a Fortune Top 10 industry leader, MinuteClinic offers a unique opportunity to deliver affordable, accessible, and comprehensive high‑quality care to patients, families, and communities. Our providers are empowered to practice holistically with strong clinical support, collaborative resources, and a unified “one store, one team” approach. This is a clinic-based role focused on delivering the highest-level quality in-person patient care. Virtual care visits may be conducted from the clinic during periods of lower onsite patient volume and when doing so does not delay or interfere with in‑person care. MinuteClinic is proud to hold the American Nurses Credentialing Center (ANCC) Pathway to Excellence® designation, recognizing our commitment to a healthy work environment through Transformational Leadership, Quality, Safety, Shared Governance, Well-being, and Professional Development. What Our Providers Enjoy Autonomy to manage your practice with dedicated collaborative and organizational support Flexible scheduling and strong work–life balance Exceptional tools, training, and clinical resources Evidence‑based guidelines and access to leading assessment and treatment planning tools Opportunity to deliver both in‑person and virtual care, driven by in‑clinic patient volume Ability to practice at the top of your license with comprehensive clinical team support Significant career growth and professional development opportunities Charting and follow‑up completed during your scheduled shift—no work taken home What you will do Deliver evidence‑based primary and family care, including assessment, diagnosis, treatment, and management of acute and chronic conditions Provide both in-person and virtual visits (from the clinic) to support positive patient health outcomes Perform diagnostic testing, preventive counseling, treatment of injuries and illnesses, and coordination of care with other healthcare professionals Engage patients in wellness services, chronic disease management, and preventive health screenings Complete essential clinic operations including inventory management, clinic opening/closing, patient follow‑up, insurance verification, and payment collection Support a safe and efficient care environment through routine examinations and timely patient appointment management Education Nurse Practitioners: Master’s degree from an accredited Family Nurse Practitioner program Current national board certification (AANP or ANCC) Active, unrestricted state APRN license Physician Associates: Master of Science in Physician Assistant/Associate Studies or health‑related master’s degree plus Bachelor of Science in PA Studies Current NCCPA certification Active, unrestricted state PA license Essential Qualifications Nurse Practitioners (NPs): One year of NP experience preferred; qualified new graduates may be considered Active, unrestricted Family Nurse Practitioner (FNP) license in good standing Ability to provide holistic, evidence‑based care including counseling related to pregnancy prevention, STI prevention, and safer sex practices Ability to order/administer vaccines and injections (COVID‑19, influenza, TB testing, Depo‑Provera, etc.) DOT certification exam completed within 30 days of employment Bilingual proficiency may be required depending on market needs Active Basic Life Support (BLS) certification Ability to pass a respirator FIT test Physical presence at assigned clinic required Physician Associates (PAs): Prior PA experience preferred; qualified new graduates considered Active, unrestricted state PA/Physician Associate license (or eligibility to obtain upon hire) DOT certification exam completed within 30 days of employment Active BLS certification Ability to pass a respirator FIT test Physical presence at assigned clinic required Physical Requirements Ability to perform duties involving prolonged standing, walking, bending, and reaching Ability to perform Basic Life Support Preferred Qualifications Experience with the EPIC electronic health record Prior MinuteClinic precepting rotation (if less than one year of provider experience; preferred but not required) Experience conducting patient assessments and exercising sound clinical decision‑making in a virtual care environment Familiarity with digital health tools and virtual communication technologies Pay Range The typical pay range for this role is: $37.66 - $81.11 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. 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 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 We anticipate the application window for this opening will close on: 06/05/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.