Utilization Management Nurse Consultant

## Utilization Management Nurse Consultant Apply:
Remote:
CT - Work from home:
Full time:
Posted Today:
End Date:
October 3, 2026 (10 days left to apply):
R1030522

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*
* *
* Location:

** Remote (Preference for candidates in Central or Eastern Time Zones)  
*
* Schedule:

** 24/7 operation; includes evenings, weekends, and holidays  Are you an experienced Registered Nurse looking to leverage your clinical expertise in a collaborative, fast-paced environment? Join our Utilization Management team and play a critical role in ensuring members receive appropriate, high-quality healthcare services across the continuum of care.  
** What You'll Do
*** Review and assess clinical information to support coverage determinations and care recommendations.
* Apply clinical guidelines, policies, and professional judgment to utilization management decisions.
* Collaborate with providers and interdisciplinary teams to coordinate care and treatment plans.
* Identify opportunities for care management referrals and enhanced member support services.
* Promote quality outcomes, effective healthcare utilization, and member-centered care.
* Serve as a clinical resource for internal and external stakeholders.
** Required Qualifications
*** Active, unrestricted RN license in your state of residence.
* 2+ years of RN experience in adult acute care or critical care settings.
* Associate Degree in Nursing (ADN).
* Strong communication, critical thinking, and multitasking skills.
* Proficiency navigating multiple computer systems in a high-volume environment.
** Preferred Qualifications
*** 2+ years of Med-Surg or specialty clinical experience.
* Utilization Management or Managed Care experience.
* BSN preferred.
* Candidates located in Eastern or Central Time Zones preferred.
** Why Join Us?
*** Apply your clinical expertise beyond the bedside.
* Work collaboratively with healthcare professionals to improve patient outcomes.
* Be part of a mission-driven team focused on quality, care coordination, and healthcare excellence.

If you're passionate about making a broader impact on patient care while utilizing your nursing expertise in a dynamic environment, we'd love to hear from you.
** 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…