Utilization Management Nurse Consultant
About The Position
CVS Health is seeking an experienced Registered Nurse for a fully remote Utilization Management role. The nurse reviews healthcare services, coordinates care, and helps ensure members receive appropriate care at the right time. The position is part of a 24/7 operation and involves collaboration with providers and healthcare teams to improve quality and outcomes. The role requires working in a fast-paced, technology-driven environment while meeting productivity and quality goals. The position requires a quiet, secure, private home workspace that complies with CVS Health and HIPAA guidelines, along with a hardwired internet connection meeting specified speed requirements. Employees must work from the state and city where they have confirmed residence. CVS Health provides computer equipment, while employees supply their own workspace furniture. The role involves extended periods at a desk and use of multiple monitors, applications, secure systems, and digital communication tools.
Requirements
- Active, unrestricted RN license in the state of residence.
- At least 2 years of RN experience in adult acute care, critical care, or medical-surgical nursing.
- Strong clinical judgment, communication, and multitasking skills.
- Comfort navigating multiple computer systems, monitors, and Microsoft Office applications.
- Ability to work independently in a remote environment.
- Associate degree in nursing required.
- Ability to obtain and maintain a direct, hardwired internet connection to a modem/router within 7 feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted.
- Maintain a quiet, secure, private, organized home workspace that complies with CVS Health and HIPAA guidelines and allows uninterrupted work.
- Work within the state and city where the employee has confirmed residence.
- Provide workspace furniture, such as a desk or standing desk, and adhere to work-from-home requirements.
- Ability to use multiple monitors and applications, communicate through digital channels, access secure systems, follow security practices, and troubleshoot common technical issues independently.
- Openness to learning new skills as the workplace environment evolves.
Nice To Haves
- Bachelor of Science in Nursing (BSN).
- Utilization Management or Managed Care experience.
- Prior experience with case management, care coordination, or health plan operations.
- Residence in the EST time zone.
Responsibilities
- Review clinical information and apply evidence-based guidelines to make coverage recommendations.
- Coordinate with providers and care teams to support treatment plans and continuity of care.
- Identify opportunities for care management referrals and improved healthcare utilization.
- Promote quality, efficiency, and positive member outcomes.
- Work in a fast-paced, technology-driven environment while meeting productivity and quality goals.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility
- Eligibility for a CVS Health bonus, commission, or short-term incentive program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
