Utilization Management Nurse Consultant

CVS Health; Colorado; Hybrid; USD 35,817 - 95,054; Full time

Benefits offered by this job

Comprehensive benefits

Remote work

Bonus eligibility

Job summary

CVS Health is seeking an experienced Utilization Management Nurse for precertification in a remote, full-time role with a 40-hour work week. You will review clinical information, apply guidelines, and authorize services while coordinating with providers and Medical Directors to ensure timely coverage decisions.

The role emphasizes critical thinking, heavy system navigation, and a non-bedside setting, enabling rapid decision-making in a production-driven environment.

Qualifications

• Active, current RN license in Virginia or a Multi-State Compact state.
• 3+ years of clinical nursing experience.
• Strong critical thinking and clinical decision-making skills.
• Proficiency navigating multiple computer systems simultaneously.
• Ability to thrive in a fast-paced, production-driven environment.
• Associate Degree in Nursing required.

Responsibilities

• Review clinical information and apply evidence-based criteria and guidelines to precertification requests.
• Collect and assess medical information from providers via phone and electronic systems.
• Authorize services and procedures within established guidelines.
• Refer complex cases to Medical Directors when additional review is required.
• Collaborate with providers and internal teams to support timely coverage decisions.
• Navigate multiple systems while managing a high-volume workload in a fast-paced environment.

Skills

RN license

Clinical nursing experience

Critical thinking

Multi-system navigation

Fast-paced environment

Education

Associate Degree in Nursing

BSN preferred

Tools

EMR systems

Job description

Utilization Management Nurse - Precertification RN

Remote | Full-Time | Weekday Schedule

Are you a clinically strong Registered Nurse who enjoys critical thinking and making evidence-based decisions? Join our Utilization Management team and play a key role in ensuring members receive appropriate, high-quality care through the precertification process.

What You'll Do

• Review clinical information and apply evidence-based criteria and clinical guidelines to precertification requests
• Collect and assess medical information from providers via phone and electronic systems
• Authorize services and procedures within established guidelines
• Refer complex cases to Medical Directors when additional review is required
• Collaborate with providers and internal teams to support timely coverage decisions
• Navigate multiple systems while managing a high-volume workload in a fast-paced environment

WHAT YOU BRING - REQUIRED

Required Qualifications

• Active, current, and unrestricted RN license in Virginia or a Multi-State Compact RN License
• 3+ years of clinical nursing experience
• Strong critical thinking and clinical decision-making skills
• Proficiency navigating multiple computer systems simultaneously
• Ability to thrive in a fast-paced, production-driven environment
• Associate Degree in Nursing required

Preferred Qualifications

• Prior Authorization or Utilization Management experience
• BSN preferred

Why Join Us?

• Utilize your clinical expertise in a non-bedside role
• Make an impact on healthcare quality and member outcomes
• Work remotely in a collaborative team environment
• Develop your utilization management and managed care experience

If you're an experienced RN looking to leverage your clinical knowledge in a dynamic utilization management role, we'd love to hear from you. Apply today!

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $68.55

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/01/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.