Utilization Management Nurse Consultant

Registered Nurse (RN) – Utilization Management

Join a dynamic healthcare team and make an impact on patient care from wherever you work.

We are seeking an experienced Registered Nurse (RN) to support our 24/7 Utilization Management operations. In this role, you will use your clinical expertise to review cases, assess medical necessity, coordinate care, and help ensure members receive appropriate, high-quality healthcare services.

What You'll Do

• Review clinical information and apply evidence-based criteria to support coverage determinations and care recommendations.
• Collaborate with providers, care teams, and internal partners to coordinate treatment and services.
• Identify opportunities to improve healthcare quality, outcomes, and benefit utilization.
• Refer members to appropriate programs and services that support their overall health needs.
• Serve as a clinical resource for utilization and benefit management questions.

What We're Looking For

Required Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years of RN experience in an adult acute care or critical care setting.
• Associate Degree in Nursing.
• Strong communication, multitasking, and computer navigation skills.
• Ability to work a designated schedule of 11:00 AM – 8:00 PM ET, including weekends, holidays, and evening hours based on business needs.

Preferred Qualifications

• BSN preferred.
• Clinical experience in Med-Surg or a specialty area.
• Managed Care and/or Utilization Management experience.
• Candidates located in the Eastern Time Zone preferred.

Why Join Us?

• Apply your clinical expertise in a collaborative, fast-paced environment.
• Help improve healthcare outcomes for members across the continuum of care.
• Work with a mission-driven team focused on quality, efficiency, and patient-centered care.

Ready to leverage your nursing experience in a rewarding Utilization Management role? Apply today.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$32.01 - $68.55

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.

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.