Utilization Management Nurse Consultant

Registered Nurse (RN) – Utilization ManagementJoin a dynamic healthcare team where your clinical expertise helps ensure members receive the right care at the right time.We are seeking an experienced Registered Nurse (RN) to support our Utilization Management team. In this role, you will review clinical information, apply evidence-based criteria and clinical judgment, communicate with providers, and help coordinate effective, high-quality healthcare services for members.What You'll DoReview and assess clinical information to support utilization and coverage determinationsCollaborate with providers, care teams, and internal partners to facilitate appropriate treatment and care plansIdentify opportunities for care management referrals and member support programsPromote quality, cost-effective healthcare outcomesServe as a clinical resource for utilization and benefit management activitiesWhat We're Looking ForRequired QualificationsActive, unrestricted RN license in state of residence2+ years of RN experience in adult acute care or critical care settingsStrong clinical assessment, communication, and computer skillsAbility to thrive in a fast-paced, highly collaborative environmentAssociates Degree in NursingPreferred Qualifications2+ years of Med-Surg or specialty clinical experienceManaged Care and/or Utilization Management experienceCandidates residing in Eastern time zones preferredBSNSchedule & Work EnvironmentUtilization Management operates 24/7Monday – Friday 8:00 am to 5:00 pm in the time zone where you live. Schedules include evenings (until 7pm), weekends, and holidays (based on business needs).Remote/office-based environment with extensive computer and telephone useSedentary role requiring effective multitasking and navigation of multiple systemsIf you're a clinically strong RN looking to leverage your expertise beyond the bedside while making a meaningful impact on patient care and healthcare outcomes, we'd love to hear from you.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 evolvesAnticipated Weekly Hours: 40Time Type: Full timePay Range: $32.01 - $68.55This 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.