Utilization Management Nurse Consultant

CVS Health•Work At Home-Connecticut, CT

2d•$32 - $69•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. Registered Nurse (RN) - Utilization Management Location: Remote (Preference for candidates in Central or Eastern Time Zones) Schedule: 24/7 operation; includes evenings, weekends, and holidays Are you an experienced Registered Nurse looking to leverage your clinical expertise in a collaborative, fast-paced environment? Join our Utilization Management team and play a critical role in ensuring members receive appropriate, high-quality healthcare services across the continuum of care.

Requirements

Active, unrestricted RN license in your state of residence.
2+ years of RN experience in adult acute care or critical care settings.
Associate Degree in Nursing (ADN).
Strong communication, critical thinking, and multitasking skills.
Proficiency navigating multiple computer systems in a high-volume environment.
Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
Openness to learning new skills in the future as the workplace environment evolves.

Nice To Haves

2+ years of Med-Surg or specialty clinical experience.
Utilization Management or Managed Care experience.
BSN preferred.
Candidates located in Eastern or Central Time Zones preferred.

Responsibilities

Review and assess clinical information to support coverage determinations and care recommendations.
Apply clinical guidelines, policies, and professional judgment to utilization management decisions.
Collaborate with providers and interdisciplinary teams to coordinate care and treatment plans.
Identify opportunities for care management referrals and enhanced member support services.
Promote quality outcomes, effective healthcare utilization, and member-centered care.
Serve as a clinical resource for internal and external stakeholders.