Utilization Management Nurse Consultant

About the Role

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. Make a difference beyond the bedside. Join our Utilization Management team and use your clinical expertise to help ensure members receive the right care at the right time.

• Review clinical information and apply evidence-based guidelines to support coverage and care decisions.
• Collaborate with providers, care teams, and internal partners to coordinate appropriate healthcare services.
• Identify opportunities to improve care quality, outcomes, and benefit utilization.
• Support members through the continuum of care by connecting them to relevant programs and resources.
• Serve as a clinical resource for utilization and benefit management activities.

• Active, unrestricted RN license in state of residence.
• Minimum 2 years of RN experience in adult acute care or critical care.
• Strong clinical judgment, communication, and organizational skills.
• Ability to work in a fast-paced environment while navigating multiple systems.

• Experience in Medical
  - Surgical or specialty nursing.
• Managed Care and/or Utilization Management experience.
• BSN preferred.
• Candidates residing in Eastern Time Zone preferred.

Office‑based/remote computer‑focused role with productivity and quality expectations. Utilization Management operates 24/7; schedules may include evenings, weekends, and holidays.

• Associate's Degree in Nursing required.
• BSN preferred.

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.

• 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…