Utilization Management Nurse Consultant (RN)
Make a meaningful impact on patient care from wherever you are.
We are seeking an experienced Registered Nurse (RN) to join our Utilization Management team. In this role, you will use your clinical expertise to review healthcare services, support appropriate care decisions, collaborate with providers, and help members navigate their healthcare journey.
What You'll Do
- Review clinical information and apply evidence-based criteria to make coverage recommendations.
- Collaborate with healthcare providers and internal teams to support quality patient outcomes.
- Identify opportunities for care coordination and member support programs.
- Promote effective healthcare utilization and contribute to high-quality service delivery.
- Manage multiple systems and priorities in a fast-paced, team-oriented environment.
Required Qualifications
- Active, unrestricted RN license in your state of residence.
- Minimum 2 years of RN experience
in an adult acute care or critical care setting .
- Associate's Degree in Nursing.
- Strong communication, computer, and multitasking skills.
- Ability to work schedules that may include evenings, weekends, and holidays
as part of a 24/7 operation.
Preferred Qualifications
- 2+ years of clinical experience in Medical-Surgical or specialty care
.
- Previous Managed Care and/or Utilization Management
experience.
- BSN preferred.
- Candidates located in Central Time Zone
preferred.
- Leverage your clinical expertise in a collaborative environment.
- Play a key role in improving healthcare quality and outcomes.
- Work with a team dedicated to delivering exceptional member care and service.
Apply today to bring your clinical knowledge to a role where every decision helps improve patient care.
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
The typical pay range for this role is
$32.01 - $68.55
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.
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 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.