Utilization Management Nurse Consultant

CVS Health; Miami (FL); Remote; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced Registered Nurse (RN) to join the Utilization Management team in a remote capacity. You will review clinical information to support coverage determinations and apply evidence-based criteria across the continuum of care.

The role requires collaboration with providers and interdisciplinary teams to improve quality and optimize benefits. Preferred candidates hold 2+ years of Med-Surg or specialty clinical experience, an active RN license in the resident state,

Qualifications

• Active, unrestricted RN license in your state of residence.
• Minimum 2 years of RN experience in an adult acute care or critical care setting.
• Associates degree in nursing.

Responsibilities

• Review and assess clinical information to support coverage determinations and recommendations.
• Apply evidence-based clinical criteria, policies, and professional judgment across the continuum of care.
• Collaborate with providers and interdisciplinary teams to coordinate care and promote positive member outcomes.
• Identify opportunities for quality improvement, care integration, and effective benefit utilization.
• Serve as a clinical resource for internal and external stakeholders.

Skills

RN license

Utilization Management

Education

Associates degree in nursing

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Utilization Management Registered Nurse (RN) - Remote

Make a meaningful impact on patient care from wherever you work.

We are seeking an experienced Registered Nurse (RN) to join our Utilization Management team, where you'll use your clinical expertise to help ensure members receive appropriate, high-quality healthcare services and benefits.

What You'll Do

• Review and assess clinical information to support coverage determinations and recommendations.
• Apply evidence-based clinical criteria, policies, and professional judgment across the continuum of care.
• Collaborate with providers and interdisciplinary teams to coordinate care and promote positive member outcomes.
• Identify opportunities for quality improvement, care integration, and effective benefit utilization.
• Serve as a clinical resource for internal and external stakeholders.

What We're Looking For

• Active, unrestricted RN license in your state of residence.
• Minimum 2 years of RN experience in an adult acute care or critical care setting.
• Associates degree in nursing.

Preferred Qualifications

• 2+ years of Med-Surg or specialty clinical experience.
• Utilization Management and/or Managed Care experience.
• Strong communication, critical thinking, and computer navigation skills.
• Ability to thrive in a fast-paced environment and manage multiple priorities.
• Candidates located in the Eastern Time Zone are strongly preferred.
• BSN preferred.

Schedule

This is a 24/7 operation, and schedules may include evenings, weekends, and holidays.

Why Join Us?

• Work remote while leveraging your clinical expertise.
• Collaborate with a dedicated healthcare team.
• Influence quality outcomes and healthcare resource utilization.
• Build your career within a growing and impactful specialty area.

Work From Home Requirements

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical And Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$26.01 - $74.78

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: 11/12/2026

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