Remote RN — Utilization Management Nurse Consultant

CVS Health; Annapolis (MD); Remote; USD 36,000 - 103,000; Full time

Job summary

CVS Health in the United States is seeking a registered nurse to coordinate utilization management from home, with EST hours and rotating weekends/holidays. This role offers a competitive base pay, bonus eligibility, and a supportive, mission‑driven team focused on safety and quality in patient care.

This role requires 3+ years of inpatient clinical practice, an unrestricted RN license, and willingness to obtain additional state licenses.

Qualifications

• 3+ years of clinical practice experience in an inpatient setting.
• RN with unrestricted state licensure required.
• Willingness to obtain additional state licenses.
• Ability to work rotating weekends

Responsibilities

• Coordinate/utilization management program activities and document care decisions.
• Consult with internal/external providers to support utilization/benefit management.
• Apply medical necessity criteria and guidelines to render coverage determinations and discharge planning.
• Evaluate care needs and facilitate appropriate healthcare services for members.
• Communicate with providers and care teams to coordinate treatment.
• Identify members who may benefit from care management referrals.
• Promote quality effectiveness of healthcare services and utilization

Skills

RN licensure

Inpatient experience

Clinical skills

Education

AA Nursing

BSN preferred

Job description

CVS Health in the United States is seeking a registered nurse to coordinate utilization management from home, with EST hours and rotating weekends/holidays. This role offers a competitive base pay, bonus eligibility, and a supportive, mission‑driven team focused on safety and quality in patient care.

This role requires 3+ years of inpatient clinical practice, an unrestricted RN license, and willingness to obtain additional state licenses.