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. Location Remote (CST/MST preferred) Schedule Monday - Friday 8:00 am to 5:00 pm in their time zone. Utilization Management is a 24/7 operation - schedules include evenings, weekends, and holidays. Make an impact beyond the bedside. Join our Utilization Management team and help ensure members receive the most appropriate, high-quality care across the healthcare continuum. What You'll Do Review clinical information and apply evidence-based guidelines to make coverage determinations Collaborate with providers and care teams to coordinate services and support treatment plans Identify opportunities to improve care quality, efficiency, and member outcomes Connect members to additional programs and resources Serve as a clinical resource for internal and external partners What You Bring - REQUIRED Active, unrestricted RN license in state of residence (required) 2+ years of adult acute or critical care experience Strong clinical judgment, communication, and multitasking skills Comfort working in a fast-paced, technology-driven environment Associate's Degree in Nursing Preferred Med-Surg or specialty clinical experience Managed care or Utilization Management experience BSN preferred Located in CST or MST Work Environment Remote, sedentary role with high-quality and productivity expectations Regular computer and phone use; ability to navigate multiple systems Why Join Us? Be part of a collaborative team that improves healthcare outcomes while expanding your clinical impact in a dynamic, non-bedside role. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $56.14 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. 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 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. We anticipate the application window for this opening will close on: 07/11/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr