Utilization Management Nurse Consultant (RN)

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

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 coverage decisions, and collaborate with providers to help ensure members receive appropriate, high-quality care.

Responsibilities

• Review clinical information and apply evidence-based criteria to make coverage recommendations
• Collaborate with physicians, providers, and care teams to coordinate treatment and services
• Identify opportunities to improve quality, outcomes, and healthcare resource utilization
• Support members through referrals to additional programs and services when appropriate
• Contribute to a fast-paced, team-oriented environment focused on delivering exceptional care

Requirements

• Active, unrestricted RN license in your state of residence
• 2+ years of recent RN experience in adult acute care or critical care

Preferred Qualifications

• Experience in Medical-Surgical (Med-Surg) nursing or another specialty area
• Prior Utilization Management or Managed Care experience
• Strong clinical assessment, critical thinking, and communication skills
• Ability to navigate multiple computer systems and manage competing priorities
• Residence in the Central Time Zone or Mountain Time Zone preferred

Education

• Associate Degree in Nursing required
• BSN preferred

Work Schedule

• This is a 24/7 operation, and schedules may include evenings, weekends, and holidays.

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

Pay Range

• $26.01 - $68.55

Benefits

• 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.