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Utilization Management Nurse Consultant

October 21, 2026

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. RN Utilization Management Nurse Consultant (Medicare – Joint Procedures) Remote | Full-Time | Monday–Friday (9:00 am to 5:30 pm in your time zone, with occasional evenings/holidays) Are you an experienced Registered Nurse looking to make an impact beyond the bedside? Join a collaborative Utilization Management team where your clinical expertise helps ensure members receive the right care at the right time. What You’ll Do <ul><li>Review and assess clinical information for Medicare precertification (joint procedures)</li><li>Apply evidence-based criteria and clinical judgment to make coverage determinations</li><li>Collaborate with providers and care teams to coordinate appropriate treatment plans</li><li>Identify opportunities to improve care quality and optimize healthcare utilization</li><li>Support care integration by connecting members to additional programs and services</li><li>Serve as a clinical resource to internal and external partners </li></ul>What You Bring - REQUIRED <ul><li>Active, unrestricted RN license in the state of residence</li><li>3+ years of RN experience</li><li>1+ year of Med/Surg experience</li><li>Proficiency in Microsoft Office (Outlook, Teams, Excel)</li><li>Associates degree in nursing </li></ul>Nice to Have <ul><li>Utilization Management or Prior Authorization experience</li><li>Managed care and/or Medicare experience</li><li>MedCompass or similar system experience</li><li>Ambulatory surgery background</li><li>BSN </li></ul>Why Join Us? <ul><li>Consistent weekday schedule (with some flexibility for a 24/7 operation)</li><li>Opportunity to use your clinical expertise in a non-bedside role</li><li>Collaborative, mission-driven team focused on quality care </li></ul>Work From Home Requirements <ul><li> You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and </li></ul>a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted. <ul><li> A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS </li></ul>Health and HIPAA guidelines, and allowing for uninterrupted work during work hours. <ul><li> Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.</li><li> The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own </li></ul>workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time). <ul><li> If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements. </li></ul>Technical And Logistical Requirements <ul><li> Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications </li></ul>simultaneously to streamline tasks and improve efficiency. <ul><li> Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and </li></ul>virtual meetings. <ul><li> Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or </li></ul>similar (Google Workspace). <ul><li> Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when </li></ul>unattended, manage strong passwords, and recognize suspicious emails or links. <ul><li> Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when </li></ul>frozen, resolving internet connection issues, and contacting IT for unresolved technical issues. <ul><li> Future Growth: Openness to learning new skills in the future as the workplace environment evolves </li></ul>Anticipated Weekly Hours 40 Time Type Full time Pay Range The Typical Pay Range For This Role Is $26.01 - $62.32 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 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. We anticipate the application window for this opening will close on: 10/22/2026 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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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...