Utilization Management Nurse Consultant; UM; CST Zone

The Utilization Management (UM) Nurse Consultant role is a fully remote position ideal for experienced nurses looking to apply their clinical expertise in a supportive environment. This position focuses on ensuring members receive safe, effective, and appropriate care while meeting regulatory requirements.

• Pay: $26.01 - $56.14/hour
• Location: Remote, KS
• Schedule: Full-time, Monday–Friday, 8:00 AM–5:00 PM CST, with occasional weekends and holidays required

• Review services for medical necessity and appropriate benefit use
• Facilitate efficient discharge planning
• Collaborate with providers and facilities to support members with complex needs
• Apply clinical skills to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits
• Collect and evaluate clinical information to make coverage determinations
• Communicate with providers and external partners to coordinate care and treatment plans
• Identify opportunities for referrals to additional programs, services, or care solutions
• Promote quality care delivery and effective benefit utilization
• Serve as a resource to internal and external stakeholders regarding UM processes and clinical considerations

• Associate Degree in Nursing (ADN) required
• Bachelor of Science in Nursing (BSN) preferred

• 2+ years of acute hospital clinical experience (strong preference for medical-surgical, ICU, behavioral health or other specialty area)
• 1+ year of Utilization Review experience preferred
• 1+ year of Managed Care experience preferred

• Active, unrestricted RN license required

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources based on eligibility

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They prioritize safety and quality while fostering a workplace where every colleague feels valued and included.