Utilization Management Nurse Consultant

Location: Work at Home, New York, United States

Job Type: Full time • Work Arrangement: Remote

Category: Clinical > Nurse

---

Overview

Join our team as a Utilization Management Nurse Consultant, where you will leverage your nursing expertise to ensure timely service requests and collaborate with leadership to enhance patient care. This remote position offers a competitive salary and comprehensive benefits.

Full Description

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 fulltime remote Utilization Management opportunity for RNs with a New York state licensure. The schedule is Monday - Friday, 8:30am - 5pm EST.

This role is a registered nurse that utilizes MCG rules and applies medical necessity guidelines to service requests. Works closely with leadership and Medical Director on member requests. This role is responsible to ensure that the service requests are addressed timely and within specific allowable turn around times.

Required Qualifications

• Registered Nurse with active and unrestricted New York state licensure
• 1+ year of Utilization review experience
• 1+ year of clinical experience 

Preferred Qualifications

• Managed Care or Managed Long Term Care experience
• Prior Authorizations

Education

• Minimum of a Bachelor's Degree in Nursing required

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 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: 11/24/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Key Skills & Requirements

• utilization review
• clinical experience
• mcg guidelines
• managed care
• prior authorizations
• stakeholder communication
• time management

---

Source: CVS Health Careers • Apply directly at official site.