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Utilization Management Nurse Consultant - Oncology and Transplant (Remote)
Overview
Utilization Management Nurse Consultant - Oncology and Transplant (Remote) role at CVS Health. This position is 100% remote within the U.S. with a Monday–Friday schedule (8:00am–4:30pm EST; shift times may vary based on business needs).
Responsibilities
- Apply critical thinking and evidence-based clinical criteria to evaluate oncology and transplant services requiring precertification.
- 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 UM Nurses across various UM specialty teams as needed to ensure 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; continuous care responsibilities during shift times are not permitted.
Required Qualifications
- Active unrestricted state RN licensure in the state of residence.
- 1+ year Oncology and Transplant UM, concurrent review or prior authorization experience.
- 3+ years acute clinical Oncology or Oncology/Transplant experience.
- Strong decision-making skills and clinical judgment in independent scenarios.
- Proficiency 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.
Additional Details
- Anticipated Weekly Hours: 40
- Time Type: Full time
- Pay Range: The typical pay range for this role is $29.10 - $62.32 per hour.
Benefits
- Competitive pay and benefits including medical plan options, a 401(k) plan (including matching contributions), and employee stock purchase plan.
- Wellness and support programs including screenings, tobacco cessation, weight management, counseling, and financial coaching.
- Benefit solutions addressing diverse needs including paid time off, flexible schedules, family leave, dependent care resources, tuition assistance, and retiree medical access.
Additional Information
The application window is expected to close on 09/17/2025. Qualified applicants with arrest or conviction records will be considered in accordance with all federal, state, and local laws.
