Utilization Review Nurse Consultant - Oncology and Transplant (Remote)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. 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 Information Schedule: Monday-Friday 11:30am-8:00pm EST Location: 100% Remote (U.S. only) 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. Remote Work Expectations: 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.

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.