Utilization Management Nurse Consultant

CVS Health•Work At Home-Florida, FL

1d•$26 - $75•Remote

About The Position

CVS Health is seeking an experienced Registered Nurse to join its Utilization Management team. This remote role uses clinical expertise to help ensure members receive appropriate, high-quality healthcare services and benefits. The nurse reviews clinical information, applies evidence-based criteria and professional judgment, collaborates with providers and interdisciplinary teams, and contributes to quality improvement and effective benefit utilization. The role also serves as a clinical resource for internal and external stakeholders. This is a full-time remote position in a 24/7 operation. Schedules may include evenings, weekends, and holidays, and the anticipated workweek is 40 hours. Employees must work from the state and city where they currently live and maintain a designated, quiet, secure home workspace that complies with CVS Health and HIPAA guidelines. A hardwired internet connection meeting the stated speed requirements is required; Wi-Fi and satellite internet are not permitted. The company provides computer equipment and related peripherals, while employees provide their own workspace furniture. The role requires comfort using multiple monitors, applications, communication platforms, and secure systems, as well as basic independent technical troubleshooting. The stated pay range is $26.01–$74.78 per hour. The position is eligible for a CVS Health bonus, commission, or short-term incentive program, in addition to a benefits package for eligible colleagues.

Requirements

Active, unrestricted RN license in the state of residence.
At least 2 years of RN experience in an adult acute care or critical care setting.
Associate degree in nursing.
Ability to obtain or 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; Wi-Fi and satellite internet are not permitted.
A quiet, secure, private, designated home workspace that is free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and suitable for uninterrupted work.
Must work within the state and city where the employee has confirmed they currently live.
Must provide workspace furniture, such as a desk or standing desk, and be able to work at a desk for extended periods.
Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.
Ability to use Microsoft Office 365 applications or similar tools such as Google Workspace.
Ability to access secure systems, use sound security practices, and recognize suspicious emails or links.
Ability to troubleshoot common technical issues independently and contact IT for unresolved issues.
Openness to learning new skills as the workplace environment evolves.

Nice To Haves

At least 2 years of Med-Surg or specialty clinical experience.
Utilization Management and/or Managed Care experience.
Strong communication, critical thinking, and computer navigation skills.
Ability to thrive in a fast-paced environment and manage multiple priorities.
Candidates located in the Eastern Time Zone are strongly preferred.
BSN preferred.

Responsibilities

Review and assess clinical information to support coverage determinations and recommendations.
Apply evidence-based clinical criteria, policies, and professional judgment across the continuum of care.
Collaborate with providers and interdisciplinary teams to coordinate care and promote positive member outcomes.
Identify opportunities for quality improvement, care integration, and effective benefit utilization.
Serve as a clinical resource for internal and external stakeholders.