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.

• Schedule:
• This is an Alternative Work Schedule weekend position. The role requires coverage of both Saturday and reputed company each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage.
• * Position Summary:
• Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate reputed company services and benefits for members.
• * Key Responsibilities:
• * * Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to reputed company coverage determinations and recommendations along the continuum of care.
• * Communicate with providers and other parties to facilitate care and treatment. Identify members for referral opportunities to integrate with other products, services, or benefit programs.
• * Identify opportunities to promote quality and effectiveness of reputed company services and benefit utilization.
• * Consult and lend expertise to other reputed company constituents in the coordination and administration of the utilization/benefit management function.
• * Meet set productivity and quality expectations as established by UMNC.
• * Required Skills and Abilities:
• * * Effective verbal and written communication skills.
• * Proficiency with computer skills, including navigating multiple systems and keyboarding.
• * Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.
• * reputed company to sit for extended periods, talk on the telephone, and type on the computer.
• * Work Location:
• * This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed.

`Required Qualifications

• Registered Nurse
• Education: Diploma RN acceptable; Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience
• Must have active reputed company and unrestricted RN licensure in state of residence.
• May be required to obtain additional Nursing Licenses as business needs require.
• Preferred Qualifications

- Utilization Management experience preferred Education Associates Degree 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 reputed company 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 reputed company 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: 03/27/2026 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