Utilization Nurse Consultant
CVS Health, Trenton, NJ, United States
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 Nurse Consultant is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
Utilization Nurse Consultant
Fully Remote – WFH.
Position Summary
UM Nurse Consultant.
Perm Schedule – Sunday‑Thursday 9am‑6pm EST.
Training Schedule – Monday‑Friday 8am‑5pm EST.
Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Required Qualifications
3+ years of experience as an RN
Active and unrestricted RN licensure in state of residence
Able to work in multiple IT platforms/systems
1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)
Must be willing to work Sun‑Thurs
Preferred Qualifications
Prior authorization utilization experience preferred
Outpatient Clinical experience
Knowledge of Medicare/Medicaid
Managed care experience
Palliative Care experience
Education
Associates Degree in Nursing required
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.
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: 04/24/2026.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr
Utilization Nurse Consultant is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
Utilization Nurse Consultant
Fully Remote – WFH.
Position Summary
UM Nurse Consultant.
Perm Schedule – Sunday‑Thursday 9am‑6pm EST.
Training Schedule – Monday‑Friday 8am‑5pm EST.
Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Required Qualifications
3+ years of experience as an RN
Active and unrestricted RN licensure in state of residence
Able to work in multiple IT platforms/systems
1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)
Must be willing to work Sun‑Thurs
Preferred Qualifications
Prior authorization utilization experience preferred
Outpatient Clinical experience
Knowledge of Medicare/Medicaid
Managed care experience
Palliative Care experience
Education
Associates Degree in Nursing required
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.
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: 04/24/2026.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr