Utilization Management Nurse Consultant Schedule: W/th/f/sa (4 - 10hr Shifts) - Remote Eligible

UM Nurse Consultant

Fully Remote- WFH

Schedule: W/Th/F/Sa (4-10hr shifts)

Position Summary

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.

Required Qualifications

3+ years of experience as an RN

Active and unrestricted RN licensure in state of residence

Able to work in multiple IT platforms/systems

1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)

Preferred Qualifications

Prior authorization utilization experience preferred

Outpatient Clinical experience

Knowledge of Medicare/Medicaid

Managed care experience

EST or CST Preferred time zones

Education

Associates Degree in Nursing required

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

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.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

We anticipate the application window for this opening will close on: 11/29/2025

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