Utilization Management Nurse Consultant

Utilization Management Nurse Consultant### Utilization Management Nurse Consultant Apply:
Remote:
PA - Work from home:
Full time:
Posted Today:
End Date:
November 3, 2026 (3 days left to apply):
R0991964

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.
** 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
* Willing to work weekends, holidays, and evening shifts.
** 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!
**** 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…