Remote Utilization Management Nurse Consultant

CVS Health Corporation; Austin (TX); Remote; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking an RN Utilization Management Nurse Consultant for a 100% remote role. The incumbent coordinates, documents and promotes utilization/benefit management to ensure appropriate care and timely discharge planning, in a workload that supports patient outcomes. Requires active RN license and hospital experience.

This full-time role offers strong benefits and a chance to impact care coordination across diverse settings while working from home in the United States.

Qualifications

• RN with active and unrestricted state licensure.
• 2+ years of acute hospital clinical experience as an RN.
• Preference for medical-surgical and ICU experience.
• Ability to handle sensitive information ethically and responsibly.
• Problem solving and decision making skills.
• Working knowledge of medical terminology and digital literacy.

Responsibilities

• Drives effective utilization management through cost‑effective allocation of resources.
• Conducts routine utilization reviews using evidence‑based criteria.
• Collaborates with providers, teams and payers to optimize care plans.
• Promotes utilization management strategies and policies with stakeholders.
• Reviews medical records to ensure compliance and provide recommendations.
• Consults with internal and external constituents in UM coordination and administration.
• Communicates with stakeholders to coordinate care and inquiries.
• Provides IC‑related coaching to nursing staff and other clinicians.

Skills

Problem solving

Medical terminology

Digital literacy

Customer communication

Ethical handling

Cost-benefit analysis

Clinical teamwork

RN

Education

Associate Degree in Nursing (minimum)

Bachelor's degree (preferred)

BSN (preferred)

Job description

CVS Health is seeking an RN Utilization Management Nurse Consultant for a 100% remote role. The incumbent coordinates, documents and promotes utilization/benefit management to ensure appropriate care and timely discharge planning, in a workload that supports patient outcomes. Requires active RN license and hospital experience.

This full-time role offers strong benefits and a chance to impact care coordination across diverse settings while working from home in the United States.