RN Utilization Management Consultant

CVS Health; Wyoming; Hybrid; USD 74,528,000 - 196,589,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Wellness programs

Job summary

CVS Health is seeking a Registered Nurse to assess, plan, implement and coordinate healthcare services for members within a utilization management framework. The role emphasizes clinical judgment and collaboration across care teams to ensure appropriate, high-quality outcomes.

The position requires an active RN license, at least two years of adult acute/critical care nursing, and availability for weekends, holidays, and evenings. It is a full-time, remote-capable role with comprehensive benefits.

Qualifications

• Active RN license in home state or state of residence
• 2+ years of RN experience in adult acute or critical care
• Available to work weekends, holidays, and evenings as required

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members
• Render coverage determinations involving clinical criteria and guidelines
• Communicate with providers to coordinate care and referrals
• Identify opportunities to promote quality and efficient utilization of healthcare services
• Lend clinical expertise to internal and external stakeholders in utilization management

Skills

RN licensure

Clinical nursing

Care coordination

Communication

Education

Associate Degree in Nursing

Tools

EHR systems

VPN access

Microsoft Office 365

Job description

CVS Health is seeking a Registered Nurse to assess, plan, implement and coordinate healthcare services for members within a utilization management framework. The role emphasizes clinical judgment and collaboration across care teams to ensure appropriate, high-quality outcomes.

The position requires an active RN license, at least two years of adult acute/critical care nursing, and availability for weekends, holidays, and evenings. It is a full-time, remote-capable role with comprehensive benefits.