Utilization Management Nurse Consultant

4004 Aetna Medicaid Administrators; Oklahoma; Hybrid; USD 36,000 - 77,000; Full time

Job summary

CVS Health in Oklahoma is seeking an experienced Utilization Management Nurse Consultant (RN) for a 100% remote role based in Oklahoma. You will review medical necessity, coordinate care, support discharge planning and provide coverage recommendations, collaborating with providers and care teams.

The ideal candidate holds an active RN license in Oklahoma, at least 2 years of acute care RN experience, and an associate degree (BSN preferred).

Qualifications

• Active, unrestricted RN license in Oklahoma.
• Minimum 2 years of acute care hospital RN experience.
• Associate Degree in Nursing; BSN preferred.

Responsibilities

• Review clinical information and authorize services based on criteria and guidelines.
• Assess medical necessity and appropriate benefit utilization.
• Coordinate care and support safe, efficient discharge planning.
• Communicate with providers and healthcare teams to facilitate treatment plans.
• Identify opportunities for care management and quality improvement.
• Document and manage utilization review activities throughout the continuum of care.

Skills

RN license Oklahoma

Acute care RN experience

Strong communication

Critical thinking

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office

EHR systems

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 Nurse Consultant (RN) - Remote Must Reside in Oklahoma.

Join a collaborative team dedicated to helping members receive the right care, at the right time, in the right setting.

As a Utilization Management Nurse Consultant, you will use your clinical expertise to review medical necessity, coordinate care, support discharge planning, and make informed coverage recommendations.

You’ll work closely with providers, facilities, and internal partners to ensure quality outcomes while meeting regulatory requirements.

Schedule 100% Remote (Oklahoma based) Monday-Friday, generally 8:00 AM-5:00 PM CST No travel required Occasional Weekend on call

What You’ll Do

• Review clinical information and authorize services based on established criteria and guidelines
• Assess medical necessity and appropriate benefit utilization
• Coordinate care and support safe, efficient discharge planning
• Communicate with providers and healthcare teams to facilitate treatment plans
• Identify opportunities for care management and quality improvement
• Document and manage utilization review activities throughout the continuum of care

Required Qualifications

• Active, unrestricted RN license in Oklahoma
• Minimum 2 years of acute care hospital RN experience
• Associate Degree in Nursing (BSN preferred)

Preferred Qualifications

• Utilization Review and/or Utilization Management experience
• Managed Care experience
• Strong communication and critical-thinking skills
• Proficiency with Microsoft Office and computer-based systems
• Ability to effectively manage multiple priorities in a fast-paced environment

If you're a clinically strong RN looking to leverage your expertise in a remote role focused on improving patient outcomes and healthcare quality, we'd love to hear from you.

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 - $56.14 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.

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.

Application window will close on

10/24/2026

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

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.