Utilization Management Nurse Consultant

CVS Health

Utilization Management Nurse Consultant at CVS Health assessing and facilitating appropriate healthcare services and benefits. Requires 2+ years RN experience and operates in a 24/7 environment.

Posted 6/26/2026full-timeRemote • Kansas • 🇺🇸 United StatesJuniorMid-Level💰 $26 - $56 per hourWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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
2+ years of clinical experience required in med surg or specialty area (preferred)
Managed Care experience preferred, especially Utilization Management (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 assessmentcare coordinationcoverage determinationclinical judgmentutilization managementadult acute carecritical caremed surgspecialty care

Soft Skills

collaborationcommunicationproblem-solvingquality improvement

Certifications

Registered Nurse (RN) licensure