CVS Health
Bringing our heart to every moment of your health.
Utilization Review Nurse Consultant – Oncology and Transplant
Location
Ohio
Posted
29 days ago
Salary
$29 - $62 / hour
Seniority
Junior
Associate Degree1 yr expExperience acceptedEnglish
Job Description
• Conduct medical necessity reviews for oncology and transplant-related services, both inpatient and outpatient.
• Collaborate with healthcare providers to gather and assess clinical documentation via phone and electronic systems.
• Apply evidence-based clinical criteria and guidelines to authorize services or refer cases to Medical Directors when needed.
• Navigate multiple computer systems efficiently while maintaining accurate and timely documentation.
• Work primarily in a 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.
Job Requirements
- Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges
- 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
- 1+ years of Managed Care (MCO) preferred
- 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
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including 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
- Many other benefits depending on eligibility
Related Guides
Related Categories
Related Job Pages
More Consultant Jobs
Consultant29 days ago
Full TimeRemoteTeam 10,001+Since 1919H1B Sponsor
Retirement Plan Consultant providing guidance aligned with retirement savings plans
United States
Consultant29 days ago
Full TimeRemoteTeam 10,001+H1B No Sponsor
Strategic Analytic Consultant supporting sales and customer success
Consultant29 days ago
Full TimeRemoteTeam 10,001+Since 1962H1B No Sponsor
Functional Consultant supporting Enterprise Testing Services for MyNavy HR
Consultant29 days ago
Full TimeRemoteTeam 51-200H1B No Sponsor
Consultant providing client support for emergency management projects




