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Position Summary
This Utilization Management Nurse Consultant (UMNC) position is 100% remote.
As a Utilization Nurse Consultant, you will utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program and our plan sponsor(s). You will be responsible for ensuring the member receives appropriate care at the appropriate time, location, and using designated criteria, while adhering to federal and state regulated turnaround times. This includes reviewing written and electronic clinical records.
We are looking for someone who is highly motivated, detail-oriented, highly organized, and works well in a team environment.
Through the use of clinical tools and information/data review, the UM Nurse Consultant reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning, and works closely with facilities and providers to meet complex needs of the member.
Required Qualifications
Must have active current and unrestricted RN license in state of residence
Minimum of 3 years of acute hospital clinical experience as an RN
Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods of time
A private designated workspace free of distractions and high‑speed internet
Must be willing and able to work Monday‑Friday 8am‑5pm EST with occasional weekend on‑call and holiday rotation
Preferred Qualifications
Candidate must possess strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues
Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
Strong telephonic communication skills
1+ years of Utilization Review experience
1+ years of Managed Care experience
Education
Associate’s Degree Required.
BSN preferred.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is $29.10 – $62.32 per hour. This represents the base hourly rate for all positions in this job grade, with total compensation potentially including bonus, commission or short‑term incentive programs.
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 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/benefits
We anticipate the application window for this opening will close on: 11/08/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.