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.

Are you an experienced Registered Nurse looking to make an impact beyond the bedside? Join a collaborative Utilization Management team where your clinical expertise helps ensure members receive the right care at the right time.

• →Review and assess clinical information for Medicare precertification (joint procedures)
• →Apply evidence-based criteria and clinical judgment to make coverage determinations
• →Collaborate with providers and care teams to coordinate appropriate treatment plans
• →Identify opportunities to improve care quality and optimize healthcare utilization
• →Support care integration by connecting members to additional programs and services
• →Serve as a clinical resource to internal and external partners

• Active, unrestricted RN license in the state of residence
• 3+ years of RN experience
• 1+ year of Med/Surg experience
• Proficiency in Microsoft Office (Outlook, Teams, Excel)
• Associates degree in nursing

• Utilization Management or Prior Authorization experience
• Managed care and/or Medicare experience
• MedCompass or similar system experience
• Ambulatory surgery background
• BSN

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and

a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.

• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS

Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.

• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own

workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).

• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications

simultaneously to streamline tasks and improve efficiency.

• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and

virtual meetings.

• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or

similar (Google Workspace).

• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when

unattended, manage strong passwords, and recognize suspicious emails or links.

• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when

frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.

• Future Growth: Openness to learning new skills in the future as the workplace environment evolves

The typical pay range for this role is:

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.