Utilization Management Nurse Consultant

Registered Nurse (RN) - Utilization Management

Make a difference beyond the bedside. Join our Utilization Management team and use your clinical expertise to help ensure members receive the right care at the right time.

What You'll Do

• Review clinical information and apply evidence-based guidelines to support coverage and care decisions.
• Collaborate with providers, care teams, and internal partners to coordinate appropriate healthcare services.
• Identify opportunities to improve care quality, outcomes, and benefit utilization.
• Support members through the continuum of care by connecting them to relevant programs and resources.
• Serve as a clinical resource for utilization and benefit management activities.

What We're Looking For - REQUIRED

• Active, unrestricted RN license in state of residence.
• Minimum 2 years of RN experience in adult acute care or critical care.
• Strong clinical judgment, communication, and organizational skills.
• Ability to work in a fast-paced environment while navigating multiple systems.

Preferred Qualifications

• Experience in Medical-Surgical or specialty nursing.
• Managed Care and/or Utilization Management experience.
• BSN preferred.
• Candidates residing in Eastern Time Zone preferred.

Schedule & Work Environment

• Office-based/remote computer-focused role with productivity and quality expectations.
• Utilization Management operates 24/7; schedules may include evenings, weekends, and holidays.

Education

• Associate's Degree in Nursing required.
• BSN preferred.

Ready to leverage your clinical expertise in a role that impacts members, providers, and healthcare outcomes every day? Apply today.

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

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.