Utilization Management Nurse Consultant
Key Skills for This Role
Full Job Posting
Registered Nurse (RN) – Utilization Management
Join a team that makes a difference in healthcare delivery. We are seeking an experienced Registered Nurse (RN) to support Utilization Management by reviewing clinical information, coordinating care, and ensuring members receive appropriate, high-quality healthcare services.
What You'll Do
Review and assess clinical information to make coverage and care recommendations
Apply clinical guidelines, policies, and nursing judgment across the continuum of care
Collaborate with providers and care teams to support treatment plans
Identify opportunities for care management programs and service integration
Promote quality outcomes and effective healthcare utilization
Serve as a clinical resource for internal and external stakeholders
Required
Active, unrestricted RN license in state of residence
2+ years of RN experience in adult acute care or critical care
Associate's degree in Nursing
Strong computer, communication, and multitasking skills
Ability to work in a fast-paced environment
Preferred
2+ years of Med-Surg or specialty clinical experience
Utilization Management and/or Managed Care experience
BSN
Residence in the Eastern Time Zone
Schedule
- 24/7 operation with schedules that may include evenings, weekends, and holidays
Why Join Us?
Work in a collaborative environment where your clinical expertise helps improve healthcare quality, optimize member outcomes, and support effective care decisions every day.
Work from Home Requirements
- You 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.
- The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
- If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.
Technical and Logistical Requirements
- 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.
- Future Growth: Openness to learning new skills in the future as the workplace environment evolves
Pay Range
- The typical pay range for this role is:
- This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
- Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
- We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
- Additional details about available benefits are provided during the application process and on Benefits Moments .
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
About CVS Health
Diversified healthcare company integrating retail, pharmacy, and insurance services.
Visit company websiteJobs and hiring trendsApply for this job in 1 click
Skip the repetitive application forms
Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.
Trusted by over 500,000 job seekers on Base Career
More from this employer
More jobs at CVS Health
Virtual Clinician Home Evaluations Nurse Practitioner or Physician Assistant (Full Time) - Nebraska
, USA
Rebate Reconciliation Process Manager
, USA
The employer is seeking a process manager to handle complex pharmaceutical rebate reconciliations while coaching analysts and improving reconciliation operations. Candidates must have at least five years of relevant anal
Project Manager - IC
, USA
Contract Negotiation Manager
, USA
Staff Software Development Engineer
, USA
Senior Analyst, Application Developer
, USA
Lead Solution Architect - Marketing Communications
, USA
Reinsurance/Stoploss Medical Claims Adjustor
, USA
Virtual Clinician Home Evaluations Nurse Practitioner or Physician Assistant (Full Time) - Nebraska
, USA
Rebate Reconciliation Process Manager
, USA