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.

RN Utilization Management Nurse Consultant (Medicare – Joint Procedures)

Remote | Full-Time | Monday–Friday (9:00 am to 6:00 pm in your time zone, with occasional evenings/holidays)

Are you an experienced Registered Nurse looking to make an impact beyond the bedside? Join a collaborative Utilization Management team where your clinical expertise helps ensure members receive the right care at the right time.

What You’ll Do

• Review and assess clinical information for Medicare precertification (joint procedures)
• Apply evidence-based criteria and clinical judgment to make coverage determinations
• Collaborate with providers and care teams to coordinate appropriate treatment plans
• Identify opportunities to improve care quality and optimize healthcare utilization
• Support care integration by connecting members to additional programs and services
• Serve as a clinical resource to internal and external partners

What You Bring - REQUIRED

• Active, unrestricted RN license in the state of residence
• 3+ years of RN experience
• 1+ year of Med/Surg experience
• Proficiency in Microsoft Office (Outlook, Teams, Excel)
• Associates degree in nursing

Nice to Have

• Utilization Management or Prior Authorization experience
• Managed care and/or Medicare experience
• MedCompass or similar system experience
• Ambulatory surgery background
• BSN

Why Join Us?

• Consistent weekday schedule (with some flexibility for a 24/7 operation)
• Opportunity to use your clinical expertise in a non-bedside role
• Collaborative, mission-driven team focused on quality care

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $62.32

This 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 people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 06/06/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.