[Hiring] Utilization Management (UM) Nurse Consultant @CVS Health

Role Description

We’re looking for an experienced and compassionate Utilization Management (UM) Nurse Consultant to join our team. This is a fully remote role available to candidates in any U.S. state in the EST Zone. You’ll apply your clinical expertise to ensure members receive safe, effective, and appropriate care—at the right time and in the right setting.

Schedule:

• Monday–Friday, 8:00 AM–5:00 PM EST
• Weekends (12 per year) and Holidays (1 minor and 1 major per year) required
• 1-10:00 AM - 7:00 PM shift per month (you can choose the day)
• No travel required

As a UM Nurse Consultant, you will use your clinical background to coordinate, document, and communicate all aspects of the utilization and benefit management process. You’ll ensure members receive the most appropriate level of care while meeting state and federal requirements and turnaround times. This role involves reviewing clinical documentation, collaborating with providers, and supporting high-quality, cost‑effective care.

Qualifications

• Active, unrestricted RN license
• 2+ years of acute hospital clinical experience (strong preference for medical‑surgical, ICU, behavioral health or other specialty area)
• Strong clinical assessment and decision‑making abilities
• Excellent organizational skills with the ability to manage multiple priorities
• Ability to work independently and communicate effectively via phone
• Comfort with computer-based work, multitasking across multiple screens, and documenting while on calls

Requirements

• 1+ year of Utilization Review experience
• 1+ year of Managed Care experience
• Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook)
• Strong telephonic communication skills
• Demonstrated ability to exercise sound judgment and collaborate with diverse teams

Education

• Associate Degree in Nursing (ADN) required
• Bachelor of Science in Nursing (BSN) preferred

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility