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Utilization Management Nurse Consultant, FL Work From Home

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R0661029 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.       Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.    UM Nurse Consultant Fully Remote- WFH   Position Summary

  • 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)
  Preferred Qualifications
  • Prior authorization utilization experience preferred
  • Outpatient Clinical experience
  • Knowledge of Medicare/Medicaid
  • Managed 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:   $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      We anticipate the application window for this opening will close on: 08/09/2025     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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