Utilization Management Nurse Consultant
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. Utilization Management (UM) Nurse Consultant (RN) Location: Remote (based on business needs) Schedule: Monday–Friday, 8:00 AM–4:30 PM (shift times may vary/occasional weekends/holidays as needed). Open to any time zone but training is EST. Make an Impact in Patient Care—Beyond the Bedside We’re seeking a driven Registered Nurse (RN) to join our Utilization Management team, where your clinical expertise helps ensure members receive the right care, at the right time, in the right setting. If you enjoy critical thinking, collaboration, and influencing care decisions, this is a great opportunity to expand your impact in healthcare.
Requirements
- Active, unrestricted RN license (state of residence)
- 3+ years of clinical RN experience (all specialties welcome)
- Strong communication and critical thinking skills
- Proficiency with Microsoft Office and navigating multiple systems
- Ability to manage priorities in a fast-paced, collaborative environment
- Associates Degree in Nursing
Nice To Haves
- Experience in Utilization Review or Managed Care
- BSN
- Strong telephonic communication and multitasking skills
Responsibilities
- Review clinical records to assess medical necessity and appropriate benefit utilization
- Apply clinical judgment and guidelines to make coverage recommendations
- Collaborate with providers and care teams to support effective treatment and discharge planning
- Coordinate and document utilization management activities across the care continuum
- Identify opportunities to improve quality, efficiency, and member outcomes
- Support referrals to additional programs and services when appropriate
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
