Utilization Management Nurse Consultant (Remote)

CVS Health•Work At Home-Arkansas, AR

1d•$26 - $56•Remote

About The Position

The Utilization Management Nurse Consultant uses clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options that facilitate appropriate healthcare services and benefits for members. The role gathers clinical information and applies clinical criteria, guidelines, policies, procedures, and judgment to make coverage determinations or recommendations along the continuum of care. It also communicates with providers and other parties to facilitate care and treatment, identifies members for referral to other products, services, or programs, and looks for opportunities to improve healthcare service quality and benefit utilization. The consultant provides expertise to internal and external stakeholders involved in utilization and benefit management. This is a remote, full-time role with 40 anticipated weekly hours. The listed schedule is standard business hours, Monday through Friday, 8:00 a.m.–5:00 p.m. CST; however, Utilization Management is a 24/7 operation, and work schedules may include weekends, holidays, and evening hours. The work is performed in a typical office or designated home work environment, with productivity and quality expectations. The position involves extended periods of sitting, telephone conversations, listening, typing, and close inspection of handwritten and computer-generated documents and a monitor. It requires multitasking, prioritization, adaptability, computer proficiency, and effective verbal and written communication. Remote colleagues must work from the state and city where they have confirmed they currently live. The home workspace must be quiet, secure, private, organized, free from distractions, compliant with CVS Health and HIPAA guidelines, and suitable for uninterrupted work. A direct, hardwired internet connection to a modem or router within seven feet of the computer is required, with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. The company provides computer equipment such as a keyboard, monitor, computer, and headset, while employees provide their own desk or standing desk. The role also requires comfort using multiple monitors and applications, digital communication and collaboration tools, secure systems such as VPNs and EHR portals, and basic troubleshooting of common technical issues. The position pays $26.01–$56.14, depending on factors such as experience, education, and geography, and is eligible for a CVS Health bonus, commission, or short-term incentive program. Eligible full-time colleagues receive a benefits package that includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, subject to eligibility.

Requirements

At least 2 years of clinical experience as a Registered Nurse in a hospital adult acute-care or critical-care setting.
Active, current, unrestricted RN licensure in the state of residence.
Ability to work schedules that may include weekends, holidays, and evening hours.
Proficiency with computer skills, including navigating multiple systems and keyboarding.
Effective verbal and written communication skills.
Ability to multitask, prioritize, and adapt to a fast-paced, changing environment.
Ability to perform close inspection of handwritten and computer-generated documents and a PC monitor.
Ability to sit for extended periods, talk on the telephone, listen, and type on a computer.
Ability to meet work-from-home requirements, including a qualifying hardwired internet connection, a secure and private workspace, and working from the state and city of confirmed residence.
Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
Ability to use digital communication tools, collaboration and scheduling applications, and secure systems; maintain computer and account security; and troubleshoot common technical issues.

Nice To Haves

At least 3 years of clinical experience in adult medical-surgical or specialty areas.
Managed care experience, especially Utilization Management.
Residence in the Central Standard Time zone.
Bachelor of Science in Nursing (BSN preferred).
Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, and PowerPoint) or similar tools such as Google Workspace.
Openness to learning new skills as the workplace environment evolves.

Responsibilities

Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage determinations or recommendations along the continuum of care.
Communicate with providers and other parties to facilitate care and treatment.
Identify members for referral opportunities to other products, services, or programs.
Identify opportunities to promote the quality and effectiveness of healthcare services and benefit utilization.
Consult with and provide expertise to internal and external stakeholders in coordinating and administering utilization and benefit management.