Utilization Management Nurse Consultant

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. Utilization Management (UM) Nurse Consultant (RN) Location: Remote (based on business needs) Schedule: Monday–Friday, 8:00 AM–4:30 PM (shift times may vary/occasional weekends/holidays as needed). Open to any time zone but training is EST. Make an Impact in Patient Care—Beyond the Bedside We’re seeking a driven Registered Nurse (RN) to join our Utilization Management team, where your clinical expertise helps ensure members receive the right care, at the right time, in the right setting. If you enjoy critical thinking, collaboration, and influencing care decisions, this is a great opportunity to expand your impact in healthcare. What You’ll Do Review clinical records to assess medical necessity and appropriate benefit utilization Apply clinical judgment and guidelines to make coverage recommendations Collaborate with providers and care teams to support effective treatment and discharge planning Coordinate and document utilization management activities across the care continuum Identify opportunities to improve quality, efficiency, and member outcomes Support referrals to additional programs and services when appropriate What You Bring - REQUIRED Active, unrestricted RN license (state of residence) 3+ years of clinical RN experience (all specialties welcome) Strong communication and critical thinking skills Proficiency with Microsoft Office and navigating multiple systems Ability to manage priorities in a fast-paced, collaborative environment Associates Degree in Nursing Preferred Experience in Utilization Review or Managed Care BSN Strong telephonic communication and multitasking skills Why Join Us? Expand your clinical impact in a non-bedside role Work with a collaborative, mission-driven team Apply your expertise to improve care quality and outcomes on a broader scale Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $68.55 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: 06/09/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply To This Job