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.

Responsibilities

• Review clinical information and apply evidence-based criteria 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 plans
• Identify opportunities to improve quality, efficiency, and healthcare utilization
• Connect members to additional programs and services as appropriate
• Serve as a clinical resource for internal and external stakeholders

Requirements

• Active, unrestricted RN license in your state of residence
• 2+ years of adult acute care and/or critical care nursing experience
• Strong clinical assessment and decision-making skills
• Ability to navigate multiple computer systems and manage competing priorities
• Excellent verbal and written communication skills

Qualifications

• Associate Degree in Nursing required
• Willing to work weekends, holidays, and evening shifts

Preferred Qualifications

• 2+ years of Med-Surg or specialty nursing experience
• Managed Care experience, particularly Utilization Management
• Reside in the Eastern Time Zone
• Bachelor’s Degree in Nursing preferred

Why Join Us?

• Use your clinical expertise in a non-bedside role
• Collaborate with experienced healthcare professionals
• Influence care quality and member outcomes on a broad scale
• Work in a dynamic environment that values critical thinking and clinical judgment

Pay

The Typical Pay Range For This Role Is $29.10 - $62.32

Benefits

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.