Utilization Management Nurse Consultant
CVS Health, Albany, NY, 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 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: $32.01 - $68.55
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.
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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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: $32.01 - $68.55
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.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr