- R0875878
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.
Utilization Management Nurse Consultant (RN) – Fully Remote
Remote | Full-Time | RN License Required
We’re seeking a motivated, detail-oriented Utilization Management Nurse Consultant (UMNC) to join our collaborative, fast-paced team. In this fully remote role, you’ll use your clinical expertise to ensure members receive the right care, at the right time, in the right setting—while supporting quality outcomes and appropriate benefit utilization.
What You’ll Do
- Review clinical records to determine medical necessity using established criteria and guidelines
- Coordinate and communicate with providers, facilities, and internal partners to support safe, effective care
- Facilitate efficient discharge planning and care transitions
- Apply clinical judgment to coverage determinations across the continuum of care
- Identify opportunities to improve quality, efficiency, and member outcomes
- Meet standard productivity and quality expectations in a dynamic environment
Schedule & Work Environment
- Monday–Friday 8-hour shift between 8:00am–6:00pm (local time zone)
- Open to PST and MST candidates to support extended coverage
- Saturday rotation required
- Up to 10% travel for audits
- Fully remote, sedentary role requiring extended computer and phone use
Required Qualifications
- Active, unrestricted RN license in the state where you reside
- 2+ years recent acute care hospital experience (within the past 10 years)
- Strong computer skills, including Microsoft Word, Excel, and PowerPoint
- Excellent written and verbal communication skills
- Highly organized, detail-oriented, and comfortable multitasking
Preferred Qualifications
- Utilization Review or Managed Care experience
- Strong telephonic communication skills
Education
- Associate Degree in Nursing required
- BSN preferred
Ready to bring your clinical expertise beyond the bedside—without sacrificing flexibility? Apply today and make an impact from home.
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 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: 05/02/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
