Utilization Management Nurse Consultant - New Jersey Registered Nurse License Required

CVS Health; New Jersey; Remote; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse for a fully remote role in Utilization Management. This position requires critical thinking and clinical expertise to manage precertification processes effectively. With a commitment to transforming health care, the company offers a supportive environment and comprehensive benefits to ensure the well-being of its colleagues. Join a team where your contributions will make a meaningful impact on the health of millions, all while enjoying the flexibility of remote work and competitive compensation.

Benefits

401(k) plan with company matching

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Tuition assistance

Flexible work schedules

Paid time off

Family leave

Confidential counseling

Financial coaching

Qualifications

• Must have active RN licensure in New Jersey or Compact RN License.
• 3+ years of clinical experience required.

Responsibilities

• Collect and review clinical information from providers.
• Authorize procedures/services or initiate Medical Director referrals.

Skills

Critical Thinking

Clinical Experience

MS Office Suite

Computer Navigation

Education

Associates Degree

BSN

Tools

MS Teams

MS Outlook

MS Word

MS Excel

Job description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Fully remote role

Must be able to work an Eastern Standard Time schedule

Must be a licensed Registered Nurse, any compact licensure must cover New Jersey

• Utilization Management is a 24/7 operation and the work schedule may include weekends, holidays, and evening hours.

• Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification.

• The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers.

• Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.

Required Qualifications

• Must have active, current and unrestricted RN licensure in New Jersey or Compact RN License

• 3+ years of clinical experience

• Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.

• 2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)

Preferred Qualifications

• Previous prior authorization experience

• Prior experience working for a health plan

Education

• Associates degree required

• BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$34.92 - $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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visithttps://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/31/2025

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