Utilization Management Nurse Consultant (RN) - Remote

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 colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.

We're seeking an experienced Registered Nurse (RN) to join our Utilization Management team. In this role, you'll use your clinical expertise to review and coordinate care, ensure appropriate healthcare services, and help members achieve the best possible outcomes.

Responsibilities

• Review clinical information and apply evidence-based criteria to coverage determinations
• Collaborate with providers, care teams, and internal partners to support quality patient care
• Identify opportunities for care coordination and program referrals
• Promote effective healthcare utilization and positive member outcomes
• Document decisions and navigate multiple systems while meeting productivity and quality goals

Requirements

• Active, unrestricted RN license in your state of residence
• Minimum 2 years of RN experience in adult acute care, critical care, med-surg, or a specialty area
• Associate Degree in Nursing

Preferred Qualifications

• Utilization Management or Managed Care experience
• BSN preferred
• Strong clinical assessment, communication, and critical thinking skills
• Ability to multitask and thrive in a technology-driven environment
• Residence in the Eastern Time Zone preferred

Schedule

Utilization Management operates 24/7. Team members should be available to work a schedule that may include evenings, weekends, and holidays.

Benefits

• Remote work opportunity
• Meaningful impact on patient care and healthcare outcomes
• Collaborative team environment
• Opportunity to apply your clinical expertise in a growing area of healthcare
• Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources

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