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 ManagementRemote | Afternoon/Evening Shifts Available | 24/7 OperationsAre you an experienced RN looking to bring your clinical expertise to a fast-paced, collaborative Utilization Management team? Join us in helping ensure members receive the appropriate care and benefits while making a meaningful impact on healthcare outcomes.ScheduleThis role supports a 24/7 operation and requires flexibility to work in your time zone:3:00 PM - 11:00 PM11:00 AM - 8:00 PM OR12:00 pm - 9:00 PMIncludes weekends and holidays as part of the schedule rotationWhat You'll DoReview clinical information and apply evidence-based criteria to support coverage determinationsAssess, coordinate, monitor, and evaluate healthcare services across the continuum of careCollaborate with providers and care teams to facilitate appropriate treatment plansIdentify opportunities to improve quality, efficiency, and healthcare utilizationConnect members to additional programs and services as appropriateServe as a clinical resource for internal and external stakeholdersWHAT YOU BRING - REQUIREDActive, unrestricted RN license in your state of residence2+ years of adult acute care and/or critical care nursing experienceStrong clinical assessment and decision-making skillsAbility to navigate multiple computer systems and manage competing prioritiesExcellent verbal and written communication skillsAssociate Degree in Nursing requiredPreferred Qualifications2+ years of Med-Surg or specialty nursing experienceManaged Care experience, particularly Utilization ManagementReside in the Eastern Time ZoneBSN preferredWhy Join Us?Use your clinical expertise in a non-bedside roleCollaborate with experienced healthcare professionalsInfluence care quality and member outcomes on a broad scaleWork in a dynamic environment that values critical thinking and clinical judgmentIf you're a compassionate RN who thrives in a fast-paced environment and enjoys combining clinical expertise with care coordination, we'd love to hear from you. Apply today!Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$29.10 - $62.32This 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 peopleWe 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: 08/15/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.