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. Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) Remote | Full-Time | Monday-Friday Are you a 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, in the right setting. What You'll Do Review clinical cases and make coverage determinations using evidence-based criteriaCollaborate with providers and interdisciplinary care teams to support treatment planningApply clinical judgment to utilization management and prior authorization decisionsIdentify opportunities to improve quality, outcomes, and member experienceServe as a trusted clinical resource for internal and external stakeholders Required Qualifications Active, unrestricted RN license in the state of residenceMinimum 3 years of RN experience, including at least 1 year in Medical-Surgical NursingStrong clinical assessment, critical thinking, and decision-making skillsProficiency with Microsoft Office applications, including Outlook, Teams, and ExcelAssociate Degree in Nursing (ADN)Ability to work Monday-Friday, 9:00 AM-5:30 PM in your local time zone Note: Utilization Management is a 24/7 operation. Schedules may include occasional evenings, weekends, and holidays based on business needs. Preferred Qualifications Utilization Management, Prior Authorization, or Care Management experienceManaged care experienceExperience using MedCompass or similar UM platformsAmbulatory surgery or outpatient clinical experienceBachelor of Science in Nursing (BSN) Why Join Us? Transition your clinical expertise into a collaborative, non-bedside roleMake a meaningful impact on healthcare quality and member outcomesWork remotely with a supportive and experienced teamExpand your knowledge of healthcare operations, utilization management, and managed careEnjoy opportunities for professional growth and development Work-from-Home Requirements Direct wired internet connection (minimum 25 Mbps download / 3 Mbps upload); Wi-Fi and satellite internet are not permittedDedicated, private workspace that complies with HIPAA and company security requirementsAbility to work from your confirmed state and city of residenceCompany-provided equipment includes computer, monitor(s), keyboard, and headsetEmployees are responsible for providing appropriate workspace furnitureCommitment to maintaining required internet speeds and remote work standards Technical Requirements Ability to navigate multiple monitors and applications simultaneouslyComfortable using Teams, Outlook, email, calendars, and virtual meeting platformsExperience with Microsoft 365 applications (Teams, Outlook, Word, Excel, PowerPoint) or similar toolsAbility to securely access systems, including VPNs and healthcare applicationsBasic troubleshooting skills, including resolving connectivity and application issuesWillingness to learn new technology and adapt to evolving business needs If you're passionate about combining clinical expertise, healthcare quality, and care coordination to improve member outcomes, we'd love to hear from you. Provide your feedback on BizChat Anticipated Weekly Hours 40 Time Type Full time Pay Range The Typical Pay Range For This Role Is $29.10 - $62.32 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. 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. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 10/26/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.