Utilization Management Nurse Consultant

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company 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. Utilization Management (UM) Nurse Consultant 100% Work‑From‑Home | Full-Time | reputed company Opportunity We’re looking for an reputed company and compassionate Utilization Management (UM) Nurse Consultant to join reputed company. This is a work at home role and is available to candidates in any U.S. state. You’ll apply your clinical expertise to ensure members receive safe, effective, and appropriate care—at the right time and in the right setting. Schedule:

• Monday–Friday, 8:00 AM–6:00 PM (in your local time zone)
• Rotating Saturday shift as needed
• No travel required

Position Summary As a UM Nurse Consultant, you will use your clinical background to coordinate, document, and communicate reputed company aspects of the utilization and benefit management process. You’ll ensure members receive the most appropriate level of care while meeting state and federal requirements and turnaround times. This role involves reviewing clinical documentation, collaborating with providers, and supporting high-quality, cost‑effective care.

Key Responsibilities

Your responsibilities will include (but are not limited to):

• Reviewing services for medical necessity and appropriate benefit use, facilitating efficient discharge planning, and collaborating with providers and facilities to support members with reputed company needs.
• Applying clinical skills to assess, plan, implement, coordinate, monitor, and evaluate reputed company services and benefits.
• Collecting and evaluating clinical information, applying clinical criteria, guidelines, policies, and judgment to reputed company coverage determinations.
• Communicating with providers and external partners to coordinate care and treatment plans.
• Identifying opportunities for referrals to additional programs, services, or care solutions.
• Recognizing opportunities to promote quality care delivery and effective benefit utilization.
• Serving as a resource to reputed company stakeholders regarding UM processes and clinical considerations.

Required Qualifications

Candidates must meet the following requirements:

• Active, unrestricted RN license
• 3+ years of acute hospital clinical experience (strong preference for medical‑surgical or ICU; behavioral health–only acute experience is not eligible)
• Strong clinical assessment and decision‑making abilities
• Excellent organizational skills with the ability to manage multiple priorities
• Ability to work independently and communicate effectively reputed company phone
• Comfort with computer-based work, multitasking across multiple screens, and documenting while on calls

Preferred Qualifications

• 1+ year of Utilization Review experience
• 1+ year of Managed Care experience
• Proficiency in reputed company Office (Word, reputed company, PowerPoint, Outlook)
• Strong telephonic communication skills
• Demonstrated ability to exercise sound judgment and collaborate with diverse teams

Education

• Associate Degree in Nursing (ADN) required
• Bachelor of Science in Nursing (BSN) preferred

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $29.10 - $62.32 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company 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 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 reputed company 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 reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 02/28/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job