Utilization Management Nurse Consultant (Work From Home)

CVS Health; Atlanta (GA); Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in the United States is seeking an Utilization Management Nurse Consultant to support clinical precertification decisions. This full-time, remote role involves reviewing cases, collaborating with providers, and applying evidence-based guidelines to determine coverage.

The position demands an active RN license, 2+ years of RN experience including Med/Surg, and strong clinical decision-making, with Monday–Friday hours in the local time zone. Comprehensive benefits are provided.

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.

Remote | Full-Time | Weekday Schedule

Utilization Management Nurse Consultant Clinical Precertification RN

What You’ll Do

• Review clinical cases and make coverage determinations using evidence-based guidelines
• Collaborate with providers, attending MDs and care teams to complete precertification requests
• Apply clinical judgment to support utilization and benefit management decisions
• Identify opportunities to improve care quality and member outcomes
• Serve as a clinical resource across internal and external stakeholders

What You Bring - REQUIRED

• Active, unrestricted RN license in the state of residence.
• 2+ years of RN experience, including 1+ year in Med/Surg
• Strong clinical assessment and decision-making skills
• Experience with Microsoft Office (Outlook, Teams, Excel)
• Ability to work Monday–Friday, 9:00 AM–6:00 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
• Associate Degree in Nursing

Preferred Qualifications

• Utilization Management or Prior Authorization experience
• Managed care background
• Ambulatory surgery background
• BSN preferred

Why Join Us?

• Transition your clinical skills into a collaborative, non-bedside role
• Make a meaningful impact on patient care and outcomes
• Work in a supportive, team-driven environment

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$26.01 - $56.14

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.

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.

We anticipate the application window for this opening will close on: 11/18/2026

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