Utilization Management Nurse Consultant

. Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members .

Posted 10/15/2026part-timeRemote • United StatesJuniorMid-Level💰 $29 - $62 per hourWebsite

Key responsibilities & impact

Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members
Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations or recommendations
Communicate with providers and other parties to facilitate care and treatment
Identify members for referral opportunities involving other products, services, or programs
Identify opportunities to promote healthcare service quality and effective benefit utilization
Consult with and provide expertise to internal and external constituents regarding utilization and benefit management
Work in a typical office environment with productivity and quality expectations
Perform close inspection of handwritten and computer-generated documents and PC monitors
Sit for extended periods, talk on the telephone, and type on a computer
Multitask, prioritize, and adapt effectively to a fast-paced, changing environment

What you’ll need

2+ years of experience as a Registered Nurse in adult acute care/critical care setting
Active, current, and unrestricted RN licensure in the state of residence
Must reside in EST or CST
Associates Degree required
Proficiency with computer skills, including navigating multiple systems and keyboarding
Ability to use multiple monitors and applications simultaneously
Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace applications
Ability to log in to secure systems such as VPN and EHR portals
Ability to manage strong passwords and recognize suspicious emails or links
Ability to resolve common technical issues independently
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 50 Mbps download and 5 Mbps upload
Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
Ability to work weekends, holidays, and evening hours in a 24/7 operation
BSN preferred
Managed Care experience preferred, especially Utilization Management

Comp & perks

Company-provided equipment (keyboard, monitor, computer, headset, etc.)
Dental benefits
Vision benefits
Wellness resources
Employee discounts
Access to certain voluntary benefits
Other programs supporting colleagues’ physical, emotional, and financial well-being