Utilization Management Nurse Consultant - Work At Home - EST Zone

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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 Title:Utilization Management Nurse (RN)

Position Summary:

This role supports a24/7 Utilization Management operation, which includes coverage duringevenings, weekends, and holidays.

The Utilization Management Nurse applies clinical expertise in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for members. The nurse uses clinical judgment and established guidelines to make coverage determinations and ensure appropriate care across the continuum.

Key Responsibilities:
  • Gather and evaluate clinical information to determine medical necessity and benefit coverage using established criteria, policies, and procedures.
  • Communicate with providers and care teams to coordinate treatment and facilitate appropriate care.
  • Identify members for referral to additional programs, services, or resources.
  • Promote quality care and effective utilization of healthcare services.
  • Serve as a clinical resource and consultant to internal and external stakeholders.
  • Maintain accurate and timely documentation in electronic systems.
  • Work in a typical office environment with expectations for productivity and quality.
  • Perform sedentary work involving extended periods of sitting, computer use, and phone communication.
  • Effectively multitask, prioritize, and adapt in a fast-paced, dynamic environment.
  • Navigate multiple systems and demonstrate strong computer proficiency.
  • Communicate clearly and professionally, both verbally and in writing.
Required Qualifications:
  • Active, unrestrictedRegistered Nurse (RN)license in state of residence.
  • Minimum2 years of RN experiencein anadult acute care or critical care setting.
  • Availability to workevenings, weekends, and holidaysas part of a 24/7 operation.
Preferred Qualifications:
  • 2+ years of clinical experiencein medical-surgical or specialty areas.
  • Managed care experience, particularly in Utilization Management.
  • Preference for candidates residing inEastern Time Zone (EST).
Education:
  • Associate Degree in Nursingrequired.
  • Bachelor of Science in Nursing (BSN)preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$32.01 - $68.55

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 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

We anticipate the application window for this opening will close on: 10/11/2025

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

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

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When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

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Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

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The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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