Utilization Management Nurse Consultant

Registered Nurse (RN) – Utilization Management (24/7 Operations)

Leverage your clinical expertise to make a broader impact. Join our Utilization Management team and help ensure members receive the right care at the right time across the healthcare continuum.

What You'll Do

• Review clinical documentation and apply criteria to support coverage determinations
• Collaborate with providers and care teams to coordinate appropriate care
• Identify opportunities to improve care quality and effective benefit utilization
• Connect members to programs and services that enhance outcomes
• Serve as a clinical resource to internal and external stakeholders

What You Bring - Required

• Active, unrestricted RN license in your state of residence
• 2+ years of adult acute care or critical care experience
• Strong clinical judgment and effective communication skills
• Ability to multitask and work efficiently in a fast-paced, technology-driven environment

Preferred Qualifications

• Experience in Med-Surg or a specialty area
• Managed Care or Utilization Management experience
• Located in the Eastern Time Zone

Schedule & Work Environment

• 24/7 operations, including evenings, weekends, and holidays
• Sedentary, computer-based role with productivity and quality expectations

Education

• Associate's Degree required
• BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$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.

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.

This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.