Utilization Management Nurse Consultant - Must reside in Florida

CVS Health; Fort Lauderdale (FL); Remote; USD 40,000 - 86,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Florida is seeking a Utilization Management Nurse Consultant. This full-time remote (work from home in Florida) role requires an active Florida RN license and at least 3 years of inpatient nursing experience.

You will review medical necessity, coordinate care, and support providers to ensure appropriate, cost-effective outcomes. The position involves 24/7 operations with evenings, weekends, and holidays.

Qualifications

• Active, unrestricted RN license in Florida.
• Minimum of 3 years inpatient clinical nursing experience.
• Willingness to obtain additional state licenses as needed.

Responsibilities

• Review clinical documentation and apply medical necessity criteria to determine coverage.
• Coordinate utilization and benefit management across the care continuum.
• Collaborate with providers and care teams to plan discharge and transitions.
• Use clinical judgment to support evidence-based care and resource use.
• Identify members for care management and facilitate referrals.
• Support urgent member needs, including triage when necessary.
• Serve as a clinical resource on utilization management processes.
• Promote quality improvement to enhance outcomes and utilization.

Skills

Clinical assessment

Documentation

Communication

Critical thinking

Education

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

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.

Position Summary

Utilization Management Nurse Consultant - must reside in Florida

Work from home anywhere in Florida. Candidates must reside in Florida.

As a Utilization Management Nurse Consultant, you will leverage your clinical expertise to review, coordinate, and manage healthcare services for members, ensuring the right care is delivered at the right time and in the most appropriate setting. This role involves evaluating clinical information, applying evidence-based guidelines and medical necessity criteria, and collaborating with providers and interdisciplinary teams to support quality, cost-effective healthcare outcomes.

Please Note:

Utilization Management is a 24/7 operation. Schedules may include evenings, weekends, and holidays.

Key Responsibilities

• Review clinical documentation and apply medical necessity criteria, policies, and clinical guidelines to make coverage determinations and recommendations.
• Coordinate and communicate all aspects of utilization and benefit management activities across the continuum of care.
• Collaborate with providers, healthcare teams, and internal stakeholders to facilitate appropriate treatment plans, discharge planning, and care transitions.
• Utilize critical thinking and clinical judgment to support evidence-based care and appropriate resource utilization.
• Identify members who may benefit from care management programs and facilitate referrals as appropriate.
• Support urgent and emergent member needs, including triage and crisis intervention when necessary.
• Serve as a clinical resource and consultant for internal and external partners regarding utilization management processes and decisions.
• Promote quality improvement initiatives and identify opportunities to enhance healthcare outcomes and benefit utilization.

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license in the state of Florida.
• Minimum of 3 years of recent inpatient clinical nursing experience.
• Ability and willingness to obtain additional state nursing licenses as needed (company-sponsored).
• Must permanently reside in Florida.
• Strong clinical assessment, documentation, communication, and critical-thinking skills.

Preferred Qualifications

• Previous Utilization Management (UM) experience.
• Managed Care experience.
• Discharge planning and care coordination experience.
• Experience applying medical necessity guidelines and utilization review criteria.

Education

• Associate Degree in Nursing (ADN) required.
• Bachelor of Science in Nursing (BSN) preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$29.10 - $62.32

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.

We anticipate the application window for this opening will close on: 11/30/2026

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