Utilization Management Nurse Consultant - Work At Home - EST Zone

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

Utilization Management operates 24/7, and work schedules will include evenings, weekends, and holidays.

This role leverages clinical expertise in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for members. Responsibilities include:

• Applying clinical criteria, guidelines, policies, procedures, and judgment to make coverage determinations across the continuum of care.
• Communicating with providers and stakeholders to facilitate appropriate treatment and care.
• Identifying members for referral to additional products, services, or programs.
• Promoting quality and effective utilization of healthcare services and benefits.
• Providing consultation and expertise to internal and external partners in support of utilization and benefit management functions.

The position is based in a work at home office environment with expectations for productivity and quality. It involves:

• Reviewing handwritten and computer-generated documents.
• Extended periods of sitting, talking on the phone, and typing.
• Multitasking and adapting to a fast-paced, dynamic setting.
• Proficiency in navigating multiple computer systems and using a keyboard.
• Strong verbal and written communication skills.

Required Qualifications

• Must reside in the Eastern Standard Time (EST) zone.
• Minimum of 2 years of experience as a Registered Nurse in an adult acute care or critical care setting.
• Active, current, and unrestricted RN license in the state of residence.
• Availability to work evenings, weekends, and holidays as part of a 24/7 operation.
• Standard shift: Monday-Friday, 8 AM-5 PM, with late shift and weekend rotation required.

Preferred Qualifications

• At least 2 years of clinical experience in medical-surgical or specialty areas.
• Prior experience in Managed Care, particularly in Utilization Management.
• Preference given to candidates residing in EST zones.

Education

• Associate's Degree in Nursing required.
• Bachelor of Science in Nursing (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: 09/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Client-provided location(s): Albany, NY

Job ID: CVS-R0702741

Employment Type: FULL_TIME

Posted: 2025-09-06T19:49:55