Utilization Management Nurse Consultant

CVS Health Corporation; Pennsylvania; Remote; USD 40,000 - 94,000; Full time

Job summary

CVS Health is seeking a Registered Nurse to join our Utilization Management team in a remote role with afternoon/evening shifts. You will review clinical information, apply criteria, coordinate care, and support coverage determinations while collaborating with providers and care teams.

Qualified candidates hold an active RN license, have 2+ years of acute or critical care experience, and are comfortable working with multiple systems.

Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years of adult acute care and/or critical care nursing experience.
• Strong clinical assessment and decision-making skills.
• Ability to navigate multiple computer systems and manage priorities.
• Excellent verbal and written communication skills.
• Associate Degree in Nursing required.
• Willing to work weekends, holidays, and evening shifts.
• Preferred: 2+ years of Med-Surg or specialty nursing experience.
• Reside in the Eastern Time Zone.

Responsibilities

• Review clinical information and apply evidence-based criteria to support coverage determinations.
• Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care.
• Collaborate with providers and care teams to facilitate appropriate treatment plans.
• Identify opportunities to improve quality, efficiency, and utilization.
• Connect members to additional programs and services as appropriate.

Skills

RN license

2+ years acute/critical care

Clinical assessment

Multisystem navigation

Verbal & written communication

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office 365

Job description

Utilization Management Nurse Consultant### Utilization Management Nurse ConsultantApply: Remote: PA - Work from home: Full time: Posted Today: End Date: November 3, 2026 (3 days left to apply): R0991964We’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.**Registered Nurse (RN) – Utilization Management****Remote | Afternoon/Evening Shifts Available | 24/7 Operations**Are you an experienced RN looking to bring your clinical expertise to a fast-paced, collaborative Utilization Management team? Join us in helping ensure members receive the appropriate care and benefits while making a meaningful impact on healthcare outcomes.**What You'll Do*** Review clinical information and apply evidence-based criteria to support coverage determinations* Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care* Collaborate with providers and care teams to facilitate appropriate treatment plans* Identify opportunities to improve quality, efficiency, and healthcare utilization* Connect members to additional programs and services as appropriate* Serve as a clinical resource for internal and external stakeholders**WHAT YOU BRING - REQUIRED*** Active, unrestricted RN license in your state of residence* 2+ years of adult acute care and/or critical care nursing experience* Strong clinical assessment and decision-making skills* Ability to navigate multiple computer systems and manage competing priorities* Excellent verbal and written communication skills* Associate Degree in Nursing required* Willing to work weekends, holidays, and evening shifts.**Preferred Qualifications*** 2+ years of Med-Surg or specialty nursing experience* Managed Care experience, particularly Utilization Management* Reside in the Eastern Time Zone* BSN preferred**Why Join Us?*** Use your clinical expertise in a non-bedside role* Collaborate with experienced healthcare professionals* Influence care quality and member outcomes on a broad scale* Work in a dynamic environment that values critical thinking and clinical judgment**If you're a compassionate RN who thrives in a fast-paced environment and enjoys combining clinical expertise with care coordination, we'd love to hear from you. Apply today!****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:$29.10 - $68.55This 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: 11/03/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.