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 Remote | Work from Home | Central Time Zone Preferred Are you an experienced Registered Nurse looking to expand your impact beyond direct patient care? Join our Utilization Management team and use your clinical expertise to help ensure members receive appropriate, high-quality, and cost-effective healthcare services. What You'll Do Review clinical information and apply evidence-based guidelines, policies, and clinical judgment to support coverage determinations Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care Collaborate with providers and care teams to facilitate appropriate treatment and care planning Identify opportunities to improve quality of care, member outcomes, and healthcare utilization Connect members with additional programs, services, and resources when appropriate Serve as a clinical resource for internal and external stakeholders What You Bring - Required Active, unrestricted RN license in your state of residence 2+ years of adult acute care and/or critical care nursing experience Strong clinical assessment, critical thinking, and communication skills Ability to multitask and work effectively in a fast-paced environment Proficiency navigating multiple computer systems and applications Associate Degree in Nursing required Preferred Qualifications 2+ years of Med-Surg or specialty nursing experience Managed Care or Utilization Management experience Residence in the Central Time Zone preferred BSN preferred Schedule & Work Environment Utilization Management operates 24/7 Schedules may include evenings, weekends, and holidays Remote, computer-based role with productivity and quality expectations Frequent collaboration with providers, members, and interdisciplinary healthcare teams Why Join Us? Apply your clinical expertise in a rewarding non-bedside role Make a meaningful impact on healthcare quality and member outcomes Work remotely as part of a collaborative clinical team Grow your career in Utilization Management and Managed Care 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 $26.01 - $56.14 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 10/10/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr