Utilization Management Registered Nurse Consultant - Remote - Virginia
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 The Utilization Management (UM) Nurse Consultant is a remote, full-time role responsible for evaluating the medical necessity and appropriateness of healthcare services using evidence-based clinical criteria. This position involves conducting utilization reviews, collaborating with healthcare providers, and supporting care coordination to ensure cost-effective and high-quality patient outcomes. The role requires strong clinical judgment, proficiency in digital systems, and the ability to work in a fast-paced environment. Key responsibilities include reviewing medical records, applying clinical guidelines for precertification, and consulting with internal and external stakeholders. The position also involves coaching healthcare staff on utilization management principles and contributing to policy development. Requirements:
- Active, unrestricted RN license (VA or compact state preferred)
- Minimum 3 years of clinical experience
- Proficiency in computer systems and multitasking
- Availability to work Monday-Friday, 8 AM-5 PM, with occasional on-call duties
Preferred:
- Prior authorization experience
- BSN degree
- Virginia residency or compact licensure
Education:
- Associate Degree in Nursing 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 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 https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 08/31/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job Apply To this Job