Utilization Management Nurse Consultant

Position Summary 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. Responsibilities Utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gather clinical information and apply the appropriate clinical criteria, guideline, policy, procedure and clinical judgment to render coverage determination or recommendation along the continuum of care. Communicate with providers and other parties to facilitate care and treatment. Identify members for referral opportunities to integrate with other products, services, and/or programs. Identify opportunities to promote the quality and effectiveness of healthcare services and benefit utilization. Consult and lend expertise to internal and external constituents in the coordination and administration of the utilization/benefit management function. Perform close inspection of handwritten and computer‑generated documents. Function in a typical office environment, maintaining productivity and quality expectations. Multitask, prioritize, and adapt effectively to a fast‑paced changing environment. Use computer skills to navigate multiple systems and keyboard inputs. Maintain effective verbal and written communication skills. Requirements Registered Nurse with 2+ years of experience in adult acute care or critical care settings. Active, current and unrestricted RN licensure in the state of residence. Availability to work a 24/7 operation schedule, including weekends, holidays, and evening hours. Preferred Qualifications 2+ years of clinical experience in medical‑surgical or specialty areas. Managed Care experience, especially in Utilization Management. Preference for candidates residing in ET zones. Education Associates Degree required; BSN preferred. Work Hours Anticipated weekly hours: 40. Full‑time position. Pay Range The typical pay range for this role is: $26.01 - $56.14 per hour (or equivalent annual salary). The actual base salary offer will depend on 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. Benefits 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. Benefits include medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources based on eligibility. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. CVS Health is an equal opportunity employer. Application Window This opening will close on 07/19/2026. #J-18808-Ljbffr