Utilization Management Nurse Consultant

Location: Northern

## Utilization Management Nurse Consultant Apply:
Remote:
IL - Work from home:
Work At Home-Ohio:
Work At Home-Texas:
Work At Home-Georgia:
Work At Home-West Virginia:
Full time:
Posted Today:
End Date:
October 11, 2026 (4 days left to apply):
R1047682

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.
* Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
* ** UM Nurse Consultant
** Fully Remote- WFHPerm Schedule
- Monday-Friday 8a-5p EST  
** Position Summary
** UM Nurse Consultant  Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

** Required Qualifications
** 3+ years of experience as an acute care RNActive and unrestricted RN licensure in state of residence

Able to work in multiple IT platforms/systems1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)  
** Preferred Qualifications
** Prior authorization utilization experience preferred

Outpatient Clinical experience

Knowledge of Medicare/Medicaid Managed care experience UM experience  
** Education
* * Associates Degree in Nursing requiredBSN preferred
** 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 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…