Utilization Management Nurse Consultant

Utilization Management Nurse (RN) – 24/7 Operations

Location: Remote (Preference for CST/MT time zones)

Schedule: Includes evenings, weekends, and holidays

Are you a detail-oriented RN with a passion for improving patient outcomes and healthcare efficiency? Join our Utilization Management team and play a key role in ensuring members receive the right care at the right time.

What You'll Do

• Review clinical information and apply guidelines to make coverage determinations across the care continuum
• Collaborate with providers and internal teams to coordinate care and support treatment plans
• Identify opportunities to enhance quality, efficiency, and member outcomes
• Refer members to appropriate programs, services, and resources
• Serve as a clinical expert in utilization and benefit management

What You Bring - Required

• Active, unrestricted RN license in your state of residence
• 2+ years of recent experience in adult acute or critical care
• Strong clinical judgment, communication, and multitasking skills
• Comfort working in a fast-paced, technology-driven environment
• Associates Degree in Nursing

Preferred Qualifications

• Experience in Med-Surg or a specialty clinical area
• Managed care or Utilization Management experience
• BSN preferred
• Residence in CST or MT time zone

Work Environment

• Remote, sedentary role with frequent computer and phone use
• Requires attention to detail, productivity, and quality standards

Why Join Us? Be part of a collaborative team that makes a meaningful impact on patient care and healthcare outcomes every day.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $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.