Remote Utilization Nurse Consultant — Impactful UM Specialist

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

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking an experienced Utilization Management Nurse Consultant for a fully remote role across EST or CST zones. You will coordinate and document UM activities, ensuring safe, appropriate care and adherence to timelines while working with providers and facilities.

The role requires an active RN license, 2+ years of acute care experience, and strong communication skills. 40-hour weeks with evenings, weekends, and holiday rotation are included in the schedule.

Qualifications

• Active, unrestricted RN license.
• 2+ years of acute hospital clinical experience (medical‑surgical, ICU, behavioral health or other specialty).
• Strong clinical assessment and decision‑making abilities.
• Excellent organizational skills with the ability to manage multiple priorities.
• Ability to work independently and communicate effectively via phone.
• Comfort with computer-based work, multitasking across multiple screens, and documenting while on calls.

Responsibilities

• Reviewing services for medical necessity and appropriate benefit use, facilitating efficient discharge planning, and collaborating with providers and facilities to support members with complex needs.
• Applying clinical skills to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits.
• Collecting and evaluating clinical information, applying clinical criteria, guidelines, policies, and judgment to make coverage determinations.
• Communicating with providers and external partners to coordinate care and treatment plans.
• Identifying opportunities for referrals to additional programs, services, or care solutions.
• Recognizing opportunities to promote quality care delivery and effective benefit utilization.
• Serving as a resource to internal and external stakeholders regarding UM processes and clinical considerations.

Skills

RN license

Acute care exp

Clinical assessment

Organizational skills

Independent work

Phone communication

Multitasking

Education

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Tools

Microsoft Office

Job description

CVS Health is seeking an experienced Utilization Management Nurse Consultant for a fully remote role across EST or CST zones. You will coordinate and document UM activities, ensuring safe, appropriate care and adherence to timelines while working with providers and facilities.

The role requires an active RN license, 2+ years of acute care experience, and strong communication skills. 40-hour weeks with evenings, weekends, and holiday rotation are included in the schedule.