Utilization Management Nurse Consultant

Registered Nurse (RN) – Utilization ManagementWe're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.Remote | Afternoon/Evening Shifts Available | 24/7 OperationsAre you an experienced RN looking to bring your clinical expertise to a fast-paced, collaborative Utilization Management team? Join us in helping ensure members receive the appropriate care and benefits while making a meaningful impact on healthcare outcomes.What You'll DoReview clinical information and apply evidence-based criteria to support coverage determinationsAssess, coordinate, monitor, and evaluate healthcare services across the continuum of careCollaborate with providers and care teams to facilitate appropriate treatment plansIdentify opportunities to improve quality, efficiency, and healthcare utilizationConnect members to additional programs and services as appropriateServe as a clinical resource for internal and external stakeholdersWhat You Bring - RequiredActive, unrestricted RN license in your state of residence2+ years of adult acute care and/or critical care nursing experienceStrong clinical assessment and decision-making skillsAbility to navigate multiple computer systems and manage competing prioritiesExcellent verbal and written communication skillsAssociate Degree in Nursing requiredWilling to work weekends, holidays, and evening shifts.Preferred Qualifications2+ years of Med-Surg or specialty nursing experienceManaged Care experience, particularly Utilization ManagementReside in the Eastern Time ZoneBSN preferredWhy Join Us?Use your clinical expertise in a non-bedside roleCollaborate with experienced healthcare professionalsInfluence care quality and member outcomes on a broad scaleWork in a dynamic environment that values critical thinking and clinical judgmentIf you're a compassionate RN who thrives in a fast-paced environment and enjoys combining clinical expertise with care coordination, we'd love to hear from you. Apply today!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: $29.10 - $62.32This 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.