Utilization Management Nurse Consultant - Concurrent Review (Remote)

CVS Health; Annapolis (MD); À distance; USD 36 000 - 103 000; Plein temps

Résumé du poste

CVS Health in the United States is seeking a registered nurse to coordinate utilization management from home, with EST hours and rotating weekends/holidays. This role offers a competitive base pay, bonus eligibility, and a supportive, mission‑driven team focused on safety and quality in patient care.

This role requires 3+ years of inpatient clinical practice, an unrestricted RN license, and willingness to obtain additional state licenses.

Qualifications

• 3+ years of clinical practice experience in an inpatient setting.
• RN with unrestricted state licensure required.
• Willingness to obtain additional state licenses.
• Ability to work rotating weekends

Responsabilités

• Coordinate/utilization management program activities and document care decisions.
• Consult with internal/external providers to support utilization/benefit management.
• Apply medical necessity criteria and guidelines to render coverage determinations and discharge planning.
• Evaluate care needs and facilitate appropriate healthcare services for members.
• Communicate with providers and care teams to coordinate treatment.
• Identify members who may benefit from care management referrals.
• Promote quality effectiveness of healthcare services and utilization

Connaissances

RN licensure

Inpatient experience

Clinical skills

Formation

AA Nursing

BSN preferred

Description du poste

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.

Position Summary

This role is work from home with the following hours: 4 ten hour shifts in EST, with rotating days off, rotating on-call weekends and holidays

Applicants must be a RN with a compact licensure required with ability to obtain additional licenses as needed.

• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
• Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
• Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
• Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
• Identifies members who may benefit from care management programs and facilitates referral
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization

Required Qualifications

• 3+ years of clinical practice experience in an inpatient setting required
• RN with unrestricted state licensure required
• Willingness to obtain additional state licenses
• Ability to work rotating weekends

Preferred Qualifications

• Managed care/utilization review experience
• Acute care/critical care experience
• Discharge planning experience

Education

AA Nursing Required

BSN Preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$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: 11/19/2026

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