Utilization Management Nurse Consultant, CVS Health

CVS Health

Location:
United States, Kansas

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

26.01 - 56.14 USD / Hour

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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. This role involves utilization management, clinical collaboration, and adapting to a fast-paced changing environment.

Job Responsibility:

utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
communicates with providers and other parties to facilitate care/treatment
identifies members for referral opportunities to integrate with other products, services and/or programs
identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

Requirements:

2+ years of experience as a Registered Nurse in adult acute care/critical care setting
must have active current and unrestricted RN licensure in state of residence
utilization management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours

Nice to have:

2+ years of clinical experience required in med surg or specialty area
managed care experience preferred, especially utilization management
preference for those residing in Central or Mountain zones

What we offer:

affordable medical plan options
401(k) plan including matching company contributions
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 including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and others depending on eligibility

Additional Information:

Job Posted:
August 26, 2025

Expiration:
August 31, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Utilization Management Nurse Consultant