Utilization Management Nurse Consultant

CVS Health; United States; Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking an experienced Utilization Management Nurse Consultant to work remotely in the United States. The role supports Medicare precertification, assesses clinical information, and renders coverage determinations in collaboration with care teams.

The position requires 3+ years of RN experience, an active RN license, and familiarity with Med/Surg and Microsoft Office. Work schedules include holidays and evenings, with a standard 40-hour week and strong HIPAA compliance.

Qualifications

• 3+ years of experience as a Registered Nurse.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)

Responsibilities

• Assess, plan, implement, coordinate and monitor options to facilitate appropriate healthcare services/benefits for members.
• Render coverage determinations/recommendations using clinical criteria/guidelines.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other programs.
• Consult and lend expertise to utilization/benefit management coordination.

Skills

RN experience

Med/Surg experience

Microsoft Office

Education

Associate degree

BSN preferred

Tools

MedCompass

Job description

## Utilization Management Nurse ConsultantApply: Remote: IL - Work from home: Work At Home-Idaho: Work At Home-Arkansas: NC - Work from home: Work At Home-Texas: Full time: Posted Today: End Date: October 25, 2026 (5 days left to apply): R1065844We’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.**Position Summary**Schedule is Monday through Friday, 9:00am to 5:30pm in the candidate's time zone. *Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours.* **Medicare Precertification Utilization Management Nurse Consultant position:*** Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.* Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.* Communicates with providers and other parties to facilitate care/treatment.* Identifies members for referral opportunities to integrate with other products, services and/or programs.* Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.* Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. **Required Qualifications*** 3+ years of experience as a Registered Nurse* Must have active current and unrestricted RN licensure in state of residence* 1+ years of Med/Surg experience* 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel) **Preferred Qualifications*** Prior Authorization or Utilization Management experience* Managed care experience* Experience using MedCompass* Ambulatory surgery experience* Medicare experience **Education*** Associates degree required* BSN preferred**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 anda 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 CVSHealth 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 ownworkspace 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 applicationssimultaneously to streamline tasks and improve efficiency.• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, andvirtual meetings.• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications orsimilar (Google Workspace).• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen whenunattended, manage strong passwords, and recognize suspicious emails or links.• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application whenfrozen, 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 - $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: 10/25/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.