Remote Utilization Management Nurse Consultant

CVS Health; United States; Remote; USD 40,000 - 85,000; Full time

Job summary

CVS Health is hiring an Utilization Management Nurse Consultant to support care coordination from home. The role requires RN licensure in the resident state and 2+ years in adult acute/critical care, with availability for a 24/7 schedule including evenings, weekends, and holidays.

Located to work from EST or CST, this position emphasizes collaboration, clinical judgment, and access to multiple systems while supporting secure, HIPAA-compliant processes.

Qualifications

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
• Must have active current and unrestricted RN licensure in state of residence.
• Must reside in EST or CST.
• Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Render coverage determination/recommendation along the continuum of care using clinical criteria and judgment.
• Communicate with providers and other parties to facilitate care and treatment.
• Identify referral opportunities to integrate with other products and programs.
• Consult and lend expertise to internal and external constituents in utilization/benefit management.

Skills

RN experience

Utilization Management

Education

Associate degree

BSN preferred

Job description

CVS Health is hiring an Utilization Management Nurse Consultant to support care coordination from home. The role requires RN licensure in the resident state and 2+ years in adult acute/critical care, with availability for a 24/7 schedule including evenings, weekends, and holidays.

Located to work from EST or CST, this position emphasizes collaboration, clinical judgment, and access to multiple systems while supporting secure, HIPAA-compliant processes.