Utilization Management Nurse Consultant

CVS Health•Work At Home-Pennsylvania, PA

1d•$29 - $62•Remote

About The Position

CVS Health is hiring a remote Registered Nurse for its Utilization Management team. The nurse reviews clinical information and applies evidence-based criteria to support coverage determinations, while assessing, coordinating, monitoring, and evaluating healthcare services across the continuum of care. The role collaborates with providers and care teams on appropriate treatment plans, identifies opportunities to improve quality, efficiency, and healthcare utilization, connects members with additional programs and services, and serves as a clinical resource for internal and external stakeholders. This is a full-time position in a 24/7 operation, with afternoon and evening shifts available. The role requires working weekends, holidays, and evening shifts. Colleagues work from home within the state and city where they currently live and have confirmed their residence. The home workspace must be quiet, secure, private, and compliant with CVS Health and HIPAA guidelines. A direct, hardwired internet connection within seven feet of the computer is required, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. CVS Health provides equipment such as a computer, monitors, keyboard, and headset, while the employee supplies workspace furniture. The position requires comfort navigating multiple monitors and applications, communicating through digital channels, using collaboration and productivity software, accessing secure systems, following security practices, and troubleshooting common technical issues. The role offers a stated hourly pay range of $29.10–$62.32 and is eligible for a CVS Health bonus, commission, or short-term incentive program. Eligible full-time benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.

Requirements

Active, unrestricted RN license in the state of residence.
At least 2 years of adult acute care and/or critical care nursing experience.
Strong clinical assessment and decision-making skills.
Ability to navigate multiple computer systems and manage competing priorities.
Excellent verbal and written communication skills.
Associate Degree in Nursing required.
Willingness to work weekends, holidays, and evening shifts.
Ability to obtain and maintain a direct, hardwired internet connection with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
A quiet, secure, private, designated home workspace that is free from distractions, compliant with CVS Health and HIPAA guidelines, and allows uninterrupted work.
Must work within the state and city where currently living and confirmed.
Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
Ability to communicate using email, calendar invitations, Teams messaging, and virtual meetings.
Ability to use Microsoft Office 365 applications or similar tools such as Google Workspace.
Ability to log in to secure systems such as VPN and EHR portals and follow computer and account security practices.
Ability to troubleshoot common technical issues and contact IT when needed.
Openness to learning new skills as the workplace evolves.
Provide own workspace furniture, such as a desk or standing desk.

Nice To Haves

At least 2 years of Med-Surg or specialty nursing experience.
Managed Care experience, particularly Utilization Management.
Residence in the Eastern Time Zone.
BSN preferred.

Responsibilities

Review clinical information and apply evidence-based criteria to support coverage determinations.
Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care.
Collaborate with providers and care teams to facilitate appropriate treatment plans.
Identify opportunities to improve quality, efficiency, and healthcare utilization.
Connect members to additional programs and services as appropriate.
Serve as a clinical resource for internal and external stakeholders.
Work weekends, holidays, and evening shifts.
Navigate multiple monitors and applications and use digital communication and collaboration tools.
Access secure systems and follow security practices, including locking unattended computers, managing strong passwords, and recognizing suspicious emails or links.
Resolve common technical issues independently and contact IT for issues that cannot be resolved.