Utilization Management Nurse Consultant

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate 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. Registered Nurse (RN) - Utilization Management Join a dynamic healthcare team where your clinical expertise helps ensure members receive the right care at the right time. We're seeking an experienced Registered Nurse (RN) to support our 24/7 Utilization Management team . In this role, you'll leverage your acute care experience and clinical judgment to review cases, assess medical necessity, coordinate care, and collaborate with providers to optimize healthcare outcomes. What You'll Do • Review clinical information and apply evidence-based criteria to make coverage recommendations • Collaborate with providers and interdisciplinary teams to support care coordination • Identify opportunities to improve quality, outcomes, and healthcare resource utilization • Refer members to appropriate programs and services that support their healthcare needs • Serve as a clinical resource for internal and external stakeholders Required Qualifications • Active, unrestricted RN license in your state of residence • 2+ years of RN experience in an adult acute care or critical care setting • Associate Degree in Nursing (ADN) • Strong communication, multitasking, and computer skills • Ability to work a flexible schedule, including evenings, weekends, and holidays Preferred Qualifications • 2+ years of Med-Surg or specialty clinical experience • Utilization Management and/or Managed Care experience • BSN preferred • Eastern Time Zone candidates preferred Why Apply? • Opportunity to make a direct impact on member care and outcomes • Collaborative, mission-driven healthcare environment • Utilize both your clinical expertise and critical thinking skills • Stable role within a fast-paced and evolving healthcare organization Ready to take your nursing career beyond the bedside? Apply today and help shape better healthcare experiences for our members.   Work from Home Requirements: • You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted. • A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours. • Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live. • The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time). • If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.   Technical and Logistical Requirements: • Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency. • Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings. • Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google