Quality Management Nurse RN 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 | 24/7 Operations Are you an experienced RN looking to transition from bedside care while continuing to make a meaningful impact on patient outcomes? Join our Utilization Management team and use your clinical expertise to help ensure members receive appropriate, high-quality, and cost-effective healthcare services. Review clinical documentation and apply evidence-based criteria, 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 plans and care coordination Identify opportunities to improve healthcare quality, effectiveness, and benefit utilization Connect members to additional programs and resources that support positive health outcomes Active, unrestricted RN license in your state of residence

• 2+ years of adult acute care and/or critical care nursing experience
• Ability to manage multiple priorities in a fast-paced, technology-driven environment
• Proficiency navigating multiple computer systems
• Associate Degree in Nursing required

2+ years of Med-Surg or specialty nursing experience

• Managed Care or Utilization Management experience
• Utilization Management is a 24/7 operation

Schedules may include evenings, weekends, and holidays Computer-based role with productivity and quality expectations Apply your clinical expertise in a rewarding non-bedside nursing role Help improve healthcare quality and member outcomes Work remotely while collaborating with an experienced clinical team Build valuable experience in Utilization Management and Managed Care If you're an RN who enjoys clinical decision-making, care coordination, and making a difference at a broader level, we'd love to hear from you. 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. 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. 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. Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace). 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. Full time 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. 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 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. 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: 10/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.