Utilization Management Nurse Consultant - Remote - EST Zone
CVS Health
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**
This is a **fully remote position** open to applicants residing in the **Eastern Standard Time Zone** . Preference is given to **West Virginia residents** or **out-of-state candidates** who hold **West Virginia RN licensure** and **compact licensure** .
The role involves applying **critical thinking** , **evidence-based clinical criteria** , and **clinical practice guidelines** to review and authorize services requiring precertification. Most of the work is conducted via phone and computer, gathering and evaluating clinical information from providers. Nurses in this role determine service authorization or escalate cases to a Medical Director when necessary.
This is a **sedentary role** , requiring extended periods of sitting, listening, speaking, and computer use.
**Required Qualifications**
+ Active, unrestricted **Registered Nurse (RN) license** in state of residence
+ Minimum of **3 years of clinical experience**
+ Availability to work **Monday–Friday, 8 AM–5 PM** , with occasional **weekend/holiday on-call** (differential pay for weekend/holiday shifts)
+ Proficiency in navigating **multiple computer systems**
+ Ability to thrive in a **fast-paced environment**
**Preferred Qualifications**
+ Prior experience in **precertification or prior authorization**
+ **West Virginia residency** preferred
+ **Compact RN licensure** preferred
+ **Bachelor of Science in Nursing (BSN)** preferred
**Education**
+ **Associate’s degree in Nursing** required
+ **BSN** preferred
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$26.01 - $56.14
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.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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