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

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.