Utilization Management Nurse Consultant

Utilization Management Nurse Consultant (RN)

Utilization Management is a 24/7 operation. Work schedules may include weekends, holidays, and evening hours.

Are you a Registered Nurse looking to leverage your clinical expertise in a collaborative, non-bedside environment? Join our Utilization Management team and help ensure members receive appropriate, high-quality healthcare services through evidence-based clinical review and care coordination.

What You'll Do

• Review clinical information and apply established guidelines, policies, and clinical judgment to make coverage determinations and recommendations.
• Assess, plan, coordinate, and monitor healthcare services to support appropriate utilization and member outcomes.
• Collaborate with providers and care teams to facilitate treatment and care coordination.
• Identify opportunities for members to benefit from additional programs, services, and resources.
• Promote quality, effectiveness, and appropriate healthcare utilization.
• Serve as a clinical resource to internal and external stakeholders on utilization and benefit management matters.
• Manage multiple priorities in a fast-paced, technology-driven environment.

What You Bring - Required

• Active, current, and unrestricted RN license in the state of residence.
• 2+ years of experience as a Registered Nurse in an adult acute care or critical care setting.
• Strong clinical assessment, critical thinking, and communication skills.
• Proficiency navigating multiple computer systems and applications.
• Ability to work schedules that may include weekends, holidays, and evening hours.

Preferred Qualifications

• 2+ years of Med/Surg or specialty nursing experience.
• Managed Care experience, particularly in Utilization Management.
• BSN preferred.

Education

• Associate Degree in Nursing required.
• Bachelor of Science in Nursing (BSN) preferred.

Why Join Us?

• Transition your clinical expertise into a collaborative healthcare management role.
• Make a meaningful impact on member care and healthcare quality.
• Work remotely in a supportive, team-oriented environment.
• Develop expertise in utilization management, care coordination, and healthcare operations.

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.