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 | Work from Home | 24/7 Operations Are you an experienced Registered Nurse looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive the right care at the right time through evidence-based clinical review and care coordination.

Review clinical information and apply guidelines, policies, and clinical judgment to support coverage determinations Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care Collaborate with providers and care teams to facilitate appropriate treatment and care planning Identify opportunities to improve quality, effectiveness, and utilization of healthcare services Connect members to additional programs and resources that support positive health outcomes 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 decision-making skills Excellent verbal and written communication skills Ability to navigate multiple systems and manage competing priorities 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 Residence in the Eastern or Central Time Zone preferred BSN preferred Schedule & Work Environment Utilization Management operates 24/7 Schedules may include evenings, weekends, and holidays Computer-based role with productivity and quality expectations Frequent collaboration with providers and interdisciplinary teams Why Join Us? Transition your clinical skills 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 Gain valuable experience in Utilization Management and Managed Care If you're an RN who thrives on clinical decision-making, care coordination, and improving healthcare outcomes, we'd love to hear from you. Apply today! 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