Job Overview: CVS Health is looking for a dedicated Utilization Management Nurse Consultant with expertise in Oncology and Transplant to join our remote team. In this critical role, you will review and authorize complex medical cases, ensuring patients receive appropriate, high-quality care while optimizing healthcare resources. As part of our innovative healthcare services, you'll collaborate with multidisciplinary teams to support oncology and transplant patients across the nation, all from the comfort of your home. Key Responsibilities: Conduct thorough clinical reviews of oncology and transplant cases, applying evidence-based guidelines such as NCCN and UNOS criteria to determine medical necessity and level of care. Communicate effectively with physicians, providers, and members to gather additional information, issue approvals or denials, and facilitate appeals processes. Monitor utilization trends, identify opportunities for care coordination, and contribute to program improvements. Maintain accurate documentation in compliance with regulatory standards, including CMS, NCQA, and state requirements. Participate in peer reviews, case consultations, and ongoing training to stay abreast of evolving treatments in oncology and transplant medicine. Required Qualifications: Active unrestricted RN license required; BSN preferred, with a minimum of 3-5 years of clinical experience in oncology, transplant, or related fields such as hematology or critical care. Prior utilization management or case management experience strongly preferred. Knowledge of medical terminology, pharmacology, and treatment protocols specific to cancer and organ transplantation. Proficiency with electronic health records (EHR) and utilization management software. Excellent critical thinking and decision-making skills under pressure. Skills: Strong clinical assessment abilities, with expertise in interpreting complex diagnostic tests, chemotherapy regimens, and post-transplant protocols. Superior communication and interpersonal skills for negotiating with providers and educating patients. Analytical mindset for data-driven utilization reviews and trend analysis. High attention to detail and organizational skills to manage high caseloads efficiently. Tech-savvy with remote work tools like secure telehealth platforms and Microsoft Office Suite. Company Info: CVS Health, a Fortune 10 healthcare leader, serves millions through integrated pharmacy, MinuteClinic, and Aetna services. We're committed to lowering costs, improving access, and enhancing health outcomes with a workforce of over 300,000 passionate professionals. Benefits: Competitive salary, comprehensive health coverage, 401(k) matching, paid time off, parental leave, and wellness programs. Enjoy remote work flexibility, professional development stipends, and employee discounts on CVS products. Growth Opportunities: Advance your career through CVS Health's robust learning platform, mentorship programs, and pathways to senior consultant, manager, or director roles. Engage in cross-functional projects and certifications in case management (CM, ACM) to expand your expertise in healthcare innovation.