Utilization Management Nurse Consultant

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 (UM) Nurse Consultant 100% Work‑From‑Home | Full-Time | Nationwide Opportunity We’re looking for an experienced and compassionate Utilization Management (UM) Nurse Consultant to join our team. This is a work at home role and is available to candidates in any U.S. state . You’ll apply your clinical expertise to ensure members receive safe, effective, and appropriate care—at the right time and in the right setting. Schedule: Monday–Friday, 8:00 AM–6:00 PM (in your local time zone) Rotating Saturday shift as needed No travel required Position Summary As a UM Nurse Consultant, you will use your clinical background to coordinate, document, and communicate all aspects of the utilization and benefit management process. You’ll ensure members receive the most appropriate level of care while meeting state and federal requirements and turnaround times. This role involves reviewing clinical documentation, collaborating with providers, and supporting high-quality, cost‑effective care. Key Responsibilities Your responsibilities will include (but are not limited to): Reviewing services for medical necessity and appropriate benefit use, facilitating efficient discharge planning, and collaborating with providers and facilities to support members with complex needs. Applying clinical skills to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits. Collecting and evaluating clinical information, applying clinical criteria, guidelines, policies, and judgment to make coverage determinations. ...