Utilization Management Nurse Consultant

CVS Health

UM Nurse Consultant utilizing clinical experience to assess and coordinate healthcare services at CVS Health. Focusing on evaluating options for members' healthcare benefits in a collaborative process.

Posted 5/6/2026full-timeRemote • Idaho, Missouri, Texas • 🇺🇸 United StatesMid-LevelSenior💰 $29 - $62 per hourWebsite

About the role

Key responsibilities & impact

Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification
The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers
Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed

Requirements

What you’ll need

Must have active, current and unrestricted RN licensure in state of Virginia or multi state compact licensure
3+ years of clinical experience
Position requires proficiency with computer skills which includes navigating multiple systems
Ability to work in a fast paced environment
Previous prior authorization experience (preferred)
Associates degree required (BSN preferred)

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical practice guidelinesprecertificationprior authorizationclinical information reviewcritical thinkingevidence-based criteriamedical director referral

Soft Skills

communicationorganizational skillsability to work in a fast-paced environment

Certifications

RN licensuremulti-state compact licensure