Utilization Management Nurse Consultant

Registered Nurse (RN) Utilization Management

Remote | Work from Home | Eastern Time Zone Preferred

Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive the right care at the right time through evidence-based clinical review, care coordination, and healthcare advocacy.

What You'll Do

• Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations
• Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care
• Collaborate with providers and care teams to facilitate appropriate treatment and care planning
• Identify opportunities to improve quality of care, member outcomes, and healthcare utilization
• Connect members with additional programs and resources that support their healthcare needs
• Serve as a clinical resource for internal and external stakeholders

What You Bring - Required

• Active, unrestricted RN license in your state of residence
• 2+ years of adult acute care and/or critical care nursing experience
• Strong clinical assessment, critical thinking, and decision-making skills
• Excellent verbal and written communication skills
• Ability to multitask and work effectively in a fast-paced environment
• Proficiency navigating multiple computer systems and applications
• Associate Degree in Nursing required

Preferred Qualifications

• 2+ years of Med-Surg or specialty nursing experience
• Managed Care or Utilization Management experience
• Residence in the Eastern Time Zone preferred
• BSN preferred

Schedule & Work Environment

• Utilization Management operates 24/7
• Schedules may include evenings, weekends, and holidays
• Remote, computer-based position with productivity and quality expectations
• Frequent collaboration with providers, members, and interdisciplinary healthcare teams

Why Join Us?

• Transition your clinical expertise into a rewarding non-bedside nursing role
• Make a meaningful impact on healthcare quality and member outcomes
• Work remotely while collaborating with an experienced clinical team
• Expand your knowledge of Utilization Management and Managed Care
• Help ensure members receive appropriate, effective, and timely care

If you're a clinically strong RN who thrives on critical thinking, care coordination, and improving healthcare outcomes, we'd love to hear from you. Apply today!

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $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.

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.