Utilization Management Nurse Consultant, CVS Health

CVS Health

Location:
United States, Remote

Category:
Nursing

Contract Type:
Employment contract

Salary:

26.01 - 56.14 USD / Hour

Save Job

Apply Position

Job Description:

The Team Lead plays a key role in supporting the daily operations of the team and serves as a vital resource for both staff and leadership. While this role does not include direct supervisory responsibilities, it requires a strong understanding of workflows, policies, and procedures to help ensure team success. The Team Lead is instrumental in onboarding new team members, monitoring quality, triaging assignments, and leading designated projects. Acting as the first point of contact for clinical issues, the Team Lead provides guidance and support to staff while maintaining open communication with leadership.

Job Responsibility:

Actively contributes to team meetings and fosters a collaborative work environment
Promoting teamwork and collaboration across the department
Serving as a knowledgeable resource and mentor to team members
Modeling best practices in clinical standards, quality, and critical thinking
Supporting adherence to plan sponsor performance goals
Assisting in the development and implementation of policies and procedures
Encouraging continuous improvement through critical thinking and feedback
Providing performance insights and coaching to enhance team effectiveness
Upholding company values, especially regarding confidentiality
Communicating clearly and effectively with diverse audiences
Managing tasks with strong organizational and prioritization skills
Supporting a positive, team-oriented work culture
Assisting supervisors as needed
Maintaining responsibility for individual caseloads, as applicable
Responding to inquiries and resolving issues promptly
Performing sedentary work, including extended periods of sitting, computer use, and document review
Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements

Requirements:

Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges
Ability to obtain licensure in non-compact states as needed
5+ years of clinical practice experience in medical healthcare
3+ years Medical Review or Utilization Management experience
2+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications
2+ years of healthcare management experience required (preferably in a managed care setting)
Ability to provide on-call UM coverage for nights and weekends on a rotational schedule
Associate's degree in nursing (RN) required

Nice to have:

Proven track record of subject matter expertise
Ability to mentor and support staff to meet business needs
BSN preferred

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
October 01, 2025

Expiration:
October 20, 2025

Employment Type:

Fulltime

Work Type:

Remote work

View All Jobs In This Company

Job Link Share:

Utilization Management Nurse Consultant