Utilization Management Nurse Consultant - Oncology and Transplant (Remote)

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Information

Schedule: Monday-Friday (Be open to working different shifts; 8:00am-4:30pm EST, 9:30am-6:00pm, or 11:30am-8:00pm EST Hours; Shift times may vary based on business needs)

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 Oncology and Transplant, 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

• 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.

• 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.

• 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 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.

• Associate's degree in nursing (RN) required, BSN preferred.

• 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.