Utilization Management Nurse Consultant - Prior Authorizations

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary

This role is Telework anywhere for prior authorizationApplies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification. Being a member advocate as well as using assessment skills to assure member needs are being met. The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.Sedentary work involves periods of sitting, talking, listening and computer useRequired Qualifications

• Must have active, current and unrestricted RN licensure in state of residence
• 3+ years of clinical experience
• Must be wiling and able to work Monday - Friday 8 am - 5 pm with occasional weekend/holiday on-call
• Position requires proficiency with computer skills which includes navigating multiple systems
• Ability to work in a fast paced environment

Preferred Qualifications

• Previous prior authorization experience
• Compact RN licensure preferred

Education

• Associates degree required
• BSN preferred

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$32.01 - $68.55This 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 peopleWe 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 08/09/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Client-provided location(s): Annapolis, MD

Job ID: CVS-R0653879

Employment Type: FULL_TIME

Posted: 2025-07-24T12:30:13