Utilization Management Nurse Consultant

CVS Health

1d • $29 - $62 • Remote

About The Position

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. 100% Remote | Nationwide We’re seeking a Utilization Management Nurse Consultant to join our high‑energy, collaborative team. In this fully remote role, you’ll apply your clinical expertise to ensure members receive the right care, at the right time, in the right setting—while meeting all regulatory and turnaround requirements.

Requirements

• Active, unrestricted RN license (CA license may be required)
• 3+ years of acute hospital RN experience (Med‑Surg and/or ICU preferred)
• Associate Degree in Nursing (required)

Nice To Haves

• 1+ year of Utilization Review and/or Managed Care experience
• Strong telephonic and professional communication skills
• Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook)
• Ability to multitask across systems while speaking with providers using a computer station and sitting for extended periods of time
• Strong clinical judgment, organization, and time‑management skills
• BSN (preferred)

Responsibilities

• Review clinical records to determine medical necessity and appropriate benefit utilization
• Coordinate and document utilization and benefit management activities
• Collaborate with providers and facilities to support safe, efficient discharge planning
• Ensure compliance with federal and state turnaround time requirements
• Communicate clearly and professionally with providers and internal partners
• Support department needs, including occasional weekend rotation and minimal travel for audits

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees