Utilization Management Nurse Consultant

CVS Health

Utilization Management Nurse Consultant at CVS Health using clinical skills for member care facilitation. Engaging in a 24/7 operation with schedule flexibility and collaborative practices.

Posted 7/2/2026full-timeRemote • South Carolina • 🇺🇸 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
Associates Degree required, BSN preferred

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Clinical JudgmentCare CoordinationCoverage DeterminationHealthcare Services EvaluationClinical Criteria Application

Soft Skills

Communication SkillsCollaborative Process Facilitation

Certifications

Active RN Licensure