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. Utilization Management Nurse Consultant (RN) – Remote (U.S.) Make an impact from home while helping members receive the right care at the right time. We are seeking a Utilization Management Nurse Consultant (RN) to join a collaborative, high-energy team in a fully remote role. In this position, you will leverage your clinical expertise to review medical records, assess medical necessity, support discharge planning, and coordinate care to ensure members receive quality, cost-effective healthcare services. What You'll Do Review clinical records to determine medical necessity and appropriate benefit utilization Coordinate and communicate utilization management activities with providers and facilities Support safe, timely, and effective discharge planning Ensure compliance with federal and state turnaround-time requirements Collaborate with interdisciplinary teams to meet complex member needs Schedule Full-time, remote position available in any U.S. state Standard hours: Monday–Friday, 8:00 AM–4:30 PM in your local time zone Candidates in PST and MST are encouraged to apply to support extended coverage through 6:30 PM EST Occasional weekend and holiday rotations based on business needs Minimal travel (up to 10%) for potential clinical audits Required Qualifications Active, unrestricted RN license in the state of residence 2+ years of recent acute care hospital RN experience (within the past 10 years) Preferred Qualifications Utilization Review experience Managed Care experience Strong telephonic communication skills BSN Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook) Education Associate Degree in Nursing required BSN preferred If you're detail-oriented, organized, and passionate about improving healthcare outcomes, we'd love to hear from you. Apply today and bring your clinical expertise to a team dedicated to delivering exceptional member care. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 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: 08/15/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.