Utilization Management Nurse Consultant

CVS Health•Work At Home-Missouri, MO

3d•$26 - $56•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. Utilization Management Nurse (RN) – 24/7 Operations Location: Remote (Preference for CST/MT time zones) Schedule: Includes evenings, weekends, and holidays Are you a detail-oriented RN with a passion for improving patient outcomes and healthcare efficiency? Join our Utilization Management team and play a key role in ensuring members receive the right care at the right time.

Requirements

Active, unrestricted RN license in your state of residence
2+ years of recent experience in adult acute or critical care
Strong clinical judgment, communication, and multitasking skills
Comfort working in a fast-paced, technology-driven environment
Associates Degree in Nursing

Nice To Haves

Experience in Med-Surg or a specialty clinical area
Managed care or Utilization Management experience
BSN preferred
Residence in CST or MT time zone

Responsibilities

Review clinical information and apply guidelines to make coverage determinations across the care continuum
Collaborate with providers and internal teams to coordinate care and support treatment plans
Identify opportunities to enhance quality, efficiency, and member outcomes
Refer members to appropriate programs, services, and resources
Serve as a clinical expert in utilization and benefit management