Utilization Management Nurse Consultant

We’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.

Registered Nurse (RN) – Utilization Management

Remote | Afternoon/Evening Shifts Available | 24/7 Operations

Are 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.

Schedule

This role supports a 24/7 operation and requires flexibility to work in your time zone:

• 3:00 PM – 11:00 PM
• 11:00 AM – 8:00 PM OR
• 12:00 pm - 9:00 PM
• Includes weekends and holidays as part of the schedule rotation

What You'll Do

• Review clinical information and apply evidence-based criteria to support coverage determinations
• Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
• Collaborate with providers and care teams to facilitate appropriate treatment plans
• Identify opportunities to improve quality, efficiency, and healthcare utilization
• Connect members to additional programs and services as appropriate
• 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 and decision-making skills
• Ability to navigate multiple computer systems and manage competing priorities
• Excellent verbal and written communication skills
• Associate Degree in Nursing required

Preferred Qualifications

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

Why Join Us?

• Use your clinical expertise in a non-bedside role
• Collaborate with experienced healthcare professionals
• Influence care quality and member outcomes on a broad scale
• Work in a dynamic environment that values critical thinking and clinical judgment

If 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!

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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