Utilization Management Nurse Consultant

CVS Health Corporation; Oklahoma City (OK); Remote; USD 74,530,000 - 160,864,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement options

Wellness programs

Job summary

CVS Health Corporation in Oklahoma is seeking an Utilization Management Nurse Consultant (RN) to review medical necessity, coordinate care, support discharge planning, and make informed coverage recommendations in a remote, Oklahoma-based role.

You will work with providers and healthcare teams to ensure quality outcomes while meeting regulatory requirements, maintain HIPAA compliance, and contribute to efficient utilization management across the continuum of care.

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 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

Skills

RN license

Acute care RN experience

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office 365

EHR portal

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

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.

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: 10/24/2026

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