[Hiring] Utilization Management Nurse Consultant @CVS Health

Role Description

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.

• 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.

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.

Requirements

• 2+ years of clinical experience in Medical-Surgical or specialty care preferred.
• Previous Managed Care and/or Utilization Management experience preferred.
• BSN preferred.
• Candidates located in Central Time Zone preferred.

Benefits

• Comprehensive and competitive mix of pay and benefits.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

Work from Home Requirements

• Direct/hardwired internet connection to a modem/router within 7 feet of your computer with 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, compliant with CVS Health and HIPAA guidelines.
• 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.).
• Commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements

• Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Ability to log in to secure systems (e.g., VPN, EHR portal) and manage strong passwords.
• Ability to resolve common technical issues independently.
• 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: $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.

Company Description

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.