Utilization Management Nurse Consultant - Weekends

CVS Health is hiring an experienced RN for a fully remote Utilization Management role focused on prior authorization. Schedule covers Saturday and Sunday (CST) plus flexible consecutive weekdays, working 10-hour shifts after training. Training is conducted Monday–Friday during business hours. UM operates 24/7, with potential evenings, holidays, or on-call coverage.

In this role, you'll review clinical documentation and apply evidence-based criteria to authorize services or escalate cases to a Medical Director. You'll communicate with providers to gather information and facilitate timely care, support appropriate utilization of healthcare benefits across the continuum of care, and identify opportunities for referrals, care coordination, and quality improvement. You'll collaborate with internal and external partners in utilization and benefit management.

Requirements: Active, unrestricted Compact RN license in the state of residence OR a Texas RN license; 3+ years of clinical nursing experience; proficiency with Microsoft Office and navigating multiple systems; strong critical thinking, communication, and multitasking skills; comfort in a fast-paced, remote, desk-based environment. Prior Authorization or UM experience preferred. ADN required, BSN preferred.

Pay range: $26.01–$56.14/hour, plus eligibility for a CVS Health bonus or short-term incentive program.