Utilization Management Nurse Consultant

About the role

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 is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Preference for those residing in Mountain or Pacific time zones.

Responsibilities

• Utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations/recommendations along the continuum of care.
• Communicate with providers and other parties to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other products, services, and/or programs.
• Identify opportunities to promote quality, effectiveness of healthcare services, and benefit utilization.
• Consult and lend expertise to internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Perform close inspection of handwritten and computer‑generated documents and monitor PC screens for accuracy.
• Maintain productivity and quality expectations in a typical office environment.
• Multitask, prioritize, and adapt to a fast‑paced, changing environment while handling extended periods of sitting, telephone conversations, and computer typing.
• Navigate multiple computer systems and demonstrate proficient keyboarding skills.
• Communicate effectively, both verbally and in writing.

Requirements

• 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting.
• Active, current, and unrestricted RN licensure in the state of residence.
• Ability to work a 24/7 schedule that includes weekends, holidays, and evening hours.
• Preferred: 2+ years of clinical experience in medical‑surgical or specialty area.
• Preferred: Managed Care experience, especially Utilization Management.
• Preferred: Residence in Mountain or Pacific time zones.

Schedule

Full‑time, 40 hours per week. The role operates 24/7 with required coverage on weekends, holidays, and evening shifts.

Pay

The typical pay range for this role is $29.10 – $62.32 per hour (or equivalent annual salary). The actual base salary will depend on 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.

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. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and additional resources, subject to eligibility. Detailed information is provided during the application process and on Benefits Moments.