Utilization Management Nurse Consultant

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 Nurse (RN) | Remote

Are you an experienced Registered Nurse looking to leverage your clinical expertise in a collaborative, fast-paced environment? Join our Utilization Management team and play a critical role in helping members receive the appropriate care and benefits they need.

What You'll Do

• Review clinical information and apply evidence-based criteria to support coverage determinations

• Collaborate with providers and interdisciplinary teams to coordinate care and optimize outcomes

• Identify opportunities to improve healthcare quality, efficiency, and member experience

• Support members by connecting them with additional programs and services when appropriate

• Serve as a clinical resource for utilization and benefit management activities

• What We're Looking For

Required:

• Active, unrestricted RN license in your state of residence
• 2+ years of RN experience in adult acute care or critical care
• Associate Degree in Nursing (ADN)

Preferred:

• BSN

• Strong clinical judgment, communication, and computer skills

• Experience in Medical-Surgical or specialty nursing

• Utilization Management or Managed Care experience

• Candidates located in the Eastern or Central Time Zone

• Work Environment

• Fully remote office environment

• Fast-paced, team-oriented setting with productivity and quality goals

• Schedule flexibility required, including evenings, weekends, and holidays as part of a 24/7 operation

• Why Join Us?

• This role offers an opportunity to apply your clinical expertise beyond bedside care while making a meaningful impact on healthcare quality, member outcomes, and effective utilization of healthcare resources.

• 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

Benefits

• Moments.

• We anticipate the application window for this opening will close on: 11/14/2026

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