Utilization Management Nurse Consultant

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

100% Remote | Nationwide

We’re seeking a Utilization Management Nurse Consultant to join our high‑energy, collaborative team. In this fully remote role, you’ll apply your clinical expertise to ensure members receive the right care, at the right time, in the right setting—while meeting all regulatory and turnaround requirements.

What You’ll Do

• Review clinical records to determine medical necessity and appropriate benefit utilization
• Coordinate and document utilization and benefit management activities
• Collaborate with providers and facilities to support safe, efficient discharge planning
• Ensure compliance with federal and state turnaround time requirements
• Communicate clearly and professionally with providers and internal partners
• Support department needs, including occasional weekend rotation and minimal travel for audits

Schedule & Coverage

• Monday–Friday, work time is an 8 hour shift between 8:00 AM–6:00 PM (local time zone)
• Weekend (Saturday) rotation as needed
• Candidates in PST or MST encouraged to apply to support extended daily coverage
• Up to 10% travel may be required for clinical audits

Required Qualifications

• Active, unrestricted RN license (CA license may be required)
• 3+ years of acute hospital RN experience (Med‑Surg and/or ICU preferred)

Preferred Qualifications

• 1+ year of Utilization Review and/or Managed Care experience
• Strong telephonic and professional communication skills
• Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook)
• Ability to multitask across systems while speaking with providers using a computer station and sitting for extended periods of time
• Strong clinical judgment, organization, and time‑management skills

Education

• Associate Degree in Nursing (required)
• BSN (preferred)

Why Join Us?

• 100% remote—work from anywhere in the U.S.
• Meaningful role influencing quality, cost‑effective care
• Supportive, fast‑paced team environment

Apply today to bring your clinical expertise to a flexible, impactful utilization management role.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$29.10 - $62.32

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 05/02/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.