Utilization Management Nurse Consultant

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Registered Nurse (RN) – Utilization Management

Remote | Utilization Management | Work from Home

Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive appropriate, high-quality care while improving healthcare outcomes across the continuum of care.

What You'll Do

• Review clinical information and apply evidence-based criteria, policies, and clinical judgment to support coverage determinations
• Assess, coordinate, monitor, and evaluate healthcare services and benefits for members
• Collaborate with providers and care teams to facilitate appropriate treatment and care planning
• Identify opportunities to improve healthcare quality, effectiveness, and utilization
• Connect members with additional programs and services that support their overall health needs
• Serve as a clinical resource for internal and external stakeholders

WHAT YOU BRING - REQUIRED

• Active, unrestricted RN license in your state of residence
• 2+ years of adult acute care and/or critical care nursing experience
• Strong clinical assessment, critical thinking, and communication skills
• Ability to navigate multiple systems and work efficiently in a fast-paced environment
• Associate Degree in Nursing required

Preferred Qualifications

• 2+ years of Med-Surg or specialty nursing experience
• Managed Care or Utilization Management experience
• Reside in the Pacific or Mountain Time Zone
• California RN License
• BSN preferred

Schedule & Work Environment

• Utilization Management operates 24/7
• Schedule may include evenings, weekends, and holidays
• Sedentary, computer-based role with productivity and quality expectations
• Frequent collaboration with providers and internal healthcare teams

Why Join Us?

• Transition your clinical expertise into a rewarding non-bedside nursing role
• Make a meaningful impact on member care and healthcare outcomes
• Work remotely while collaborating with a supportive clinical team
• Grow your expertise in Utilization Management and Managed Care

If you're a detail-oriented RN with strong clinical judgment and a passion for improving patient outcomes, we'd love to hear from you. Apply today!

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

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.