Utilization Management Nurse Consultant

About the role

We are seeking an experienced Registered Nurse (RN) to support our 24/7 Utilization Management operations. In this role, you will use your clinical expertise to review cases, assess medical necessity, coordinate care, and help ensure members receive appropriate, high-quality healthcare services.

Responsibilities

• Review clinical information and apply evidence-based criteria to support coverage determinations and care recommendations.
• Collaborate with providers, care teams, and internal partners to coordinate treatment and services.
• Identify opportunities to improve healthcare quality, outcomes, and benefit utilization.
• Refer members to appropriate programs and services that support their overall health needs.
• Serve as a clinical resource for utilization and benefit management questions.

Requirements

• Active, unrestricted RN license in your state of residence.
• 2+ years of RN experience in an adult acute care or critical care setting.
• Associate Degree in Nursing.
• Strong communication, multitasking, and computer navigation skills.
• Ability to work a designated schedule of 11:00 AM – 8:00 PM ET, including weekends, holidays, and evening hours based on business needs.

Preferred Qualifications

• BSN preferred.
• Clinical experience in Med-Surg or a specialty area.
• Managed Care and/or Utilization Management experience.
• Candidates located in the Eastern Time Zone preferred.

Benefits

The typical pay range for this role is $32.01 - $68.55. 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.

Pay

The anticipated weekly hours for this role are 40. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Schedule

This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.