Utilization Management Nurse Consultant, CVS Health

CVS Health

Location:
United States, Work at Home

Category:
Nursing

Contract Type:
Employment contract

Salary:

29.10 - 62.32 USD / Hour

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Job Description:

Utilization Management Nurse Consultant position at CVS Health focusing on transforming health care through clinical assessment and coordination of healthcare services for members. The role involves applying clinical criteria and judgment to render coverage determinations, communicating with providers, and identifying opportunities to improve healthcare quality and effectiveness.

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
Associates Degree required
BSN preferred
Proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written

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 PST zones

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
October 01, 2025

Expiration:
October 11, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Utilization Management Nurse Consultant