Utilization Management Nurse Consultant

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.

Registered Nurse (RN) Utilization Management

Make an impact on patient care from wherever you are. We're seeking experienced Registered Nurses to join our Utilization Management team, where you'll use your clinical expertise to ensure members receive the appropriate care and resources they need throughout their healthcare journey.

What You'll Do

• Review clinical information and apply evidence-based criteria to make coverage and authorization determinations.
• Collaborate with physicians, providers, and interdisciplinary teams to support quality patient outcomes.
• Identify opportunities for care coordination, case management, and other healthcare programs.
• Promote effective healthcare utilization and member-centered care.
• Serve as a clinical resource and partner for internal and external stakeholders.

What We're Looking For

Required:

• Active, unrestricted RN license in your state of residence.
• 2+ years of Registered Nurse experience in an adult acute care or critical care setting.
• Associate Degree in Nursing (ADN).

Preferred:

• 2+ years of Med-Surg or specialty clinical experience.
• Utilization Management or Managed Care experience.
• BSN preferred.
• Candidates located in the Eastern Time Zone are strongly preferred.

Schedule & Work Environment

• Utilization Management is a 24/7 operation; schedules may include evenings, weekends, and holidays.
• Fast-paced, collaborative environment requiring strong multitasking and communication skills.
• Computer-based role requiring navigation of multiple systems and documentation platforms.

Why Join Us?

Bring your clinical expertise to a role that combines patient advocacy, critical thinking, and healthcare decision-making. You'll work alongside experienced professionals dedicated to improving healthcare quality, outcomes, and member experiences every day.

Apply today and help ensure patients receive the right care at the right time.

Work from Home Requirements:

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $74.78

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.

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