Remote UM Nurse Consultant Medical Review, OH

CVS Health

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OH – Work from home
Full time
Posted Today

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.




Position Summary:


This position will be remote working from home anywhere in the US.

Schedule is Monday – Friday 8am-5pm est.

No travel required.

Non-exempt. Hourly. Pay: Bi-weekly.  No shift premium.

Occasional Overtime may be required.


Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases .


Applies the appropriate clinical criteria/guideline 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.


For more information on our benefit programs, please visit


Required Qualifications:

-3+ Years of clinical experience

-1+ Year of Utilization Review Management and/or Medical Management experience.

-Must have active and unrestricted RN license in the state you reside.

-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

-Required to attend all classes the first 3 weeks of initial training required with 100% participation during 8:00am-5pm Monday-Friday


Preferred Qualifications:

– MCG Milliman, InterQual, or other guideline application Experience



Associate Degree required.

BSN preferred.





Pay Range

The typical pay range for this role is:


$29.10 – $62.31


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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  

For more detailed information on available benefits, please visit




We anticipate the application window for this opening will close on: 04/09/2024