Utilization Management Nurse Consultant

Registered Nurse (RN) – Utilization Management

Join 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 Do

• Review and assess clinical information to support utilization and coverage determinations
• Collaborate with providers, care teams, and internal partners to facilitate appropriate treatment and care plans
• Identify opportunities for care management referrals and member support programs
• Promote quality, cost-effective healthcare outcomes
• Serve as a clinical resource for utilization and benefit management activities

What We're Looking For

• Active, unrestricted RN license in state of residence
• 2+ years of RN experience in adult acute care or critical care settings
• Strong clinical assessment, communication, and computer skills
• Ability to thrive in a fast-paced, highly collaborative environment
• Associates Degree in Nursing

• Med-Surg or specialty clinical experience
• Managed Care and/or Utilization Management experience
• Candidates residing in Eastern time zones preferred
• BSN

Schedule & Work Environment

• Utilization Management operates 24/7
• Monday – Friday 8:00 am to 5:00 pm in the time zone where you live. Schedules include evenings (until 7pm), weekends, and holidays
• Remote/office-based environment with extensive computer and telephone use
• Sedentary role requiring effective multitasking and navigation of multiple systems

If 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.

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.

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.