Remote Utilization Management Nurse Consultant

CVS Health Corporation; Des Moines (IA); Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Eligibility for CVS Health bonus/inz-

Job summary

CVS Health Corporation is seeking an experienced Utilization Management Nurse Consultant to support remote, full-time operations. This role is open to CST residents with a 40-hour workweek and a schedule that fits hospital-like shifts while maintaining work‑life balance.

The UM Nurse Consultant will review medical necessity, coordinate care, document outcomes, and communicate with providers to ensure high‑quality, cost‑effective care for members.

Qualifications

• Active, unrestricted RN license and ADN required.
• 2+ years of acute hospital clinical experience preferred.
• Strong clinical assessment and decision-making abilities.
• Ability to work independently and manage multiple priorities.

Responsibilities

• Review medical necessity and appropriate benefit use.
• Coordinate discharge planning with providers and facilities.
• Assess, plan, implement, coordinate, monitor, and evaluate services.
• Collect and evaluate clinical information for coverage determinations.
• Communicate with providers and external partners to coordinate care.
• Identify opportunities for referrals to additional programs and services.
• Serve as a resource on UM processes and clinical considerations.

Skills

RN license

Acute hospital experience

Independent work

Multitasking

Phone communication

Computer literacy

Education

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Tools

Microsoft Office

Job description

CVS Health Corporation is seeking an experienced Utilization Management Nurse Consultant to support remote, full-time operations. This role is open to CST residents with a 40-hour workweek and a schedule that fits hospital-like shifts while maintaining work‑life balance.

The UM Nurse Consultant will review medical necessity, coordinate care, document outcomes, and communicate with providers to ensure high‑quality, cost‑effective care for members.