Registered Nurse (RN) Utilization Management Nurse Consultant - Remote
Make a difference in patient care from the comfort of home.
We're seeking experienced Registered Nurses to join our Utilization Management team in a fully remote role. In this position, you'll leverage your clinical expertise to review healthcare services, coordinate care, and help ensure members receive the right care at the right time. As part of a 24/7 operation, you'll collaborate with providers and healthcare teams while playing a key role in improving quality and outcomes.
What You'll Do
- 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.
What You'll Bring - Required
- Active, unrestricted RN license in your state of residence.
- 2+ years of RN experience in adult acute care, critical care, or medical-surgical.
- 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.
- Associates degree in nursing required – BSN Preferred.
Preferred Qualifications
- Utilization Management or Managed Care experience.
- Prior experience with case management, care coordination, or health plan operations.
- EST time zone residency preferred.
Work Schedule
- Utilization Management is a 24/7 operation.
- Schedules may include evenings, weekends, and holidays.
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.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is
$29.10 - $62.32