Organization
CVS Health
Location
Work at Home – New Jersey, United States
Job ID
R0765960
Category
Clinical Nursing
Work Arrangement
Fully Remote
Schedule
Full-time: 40 hours per week. Eastern Standard Time with rotational shifts (may include evenings, weekends, and holidays).
Pay Range
$34.92 to $74.78 per hour. Competitive package plus bonus and incentive eligibility.
Application Deadline
December 31, 2025
About CVS Health
CVS Health is one of the largest and most trusted health solutions companies in the United States. The organization supports millions of consumers through its local presence, digital platforms, and a workforce of over 300,000 purpose-driven colleagues. The mission centers on delivering more connected, more convenient, and more compassionate care every day.
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Role Overview
The Utilization Management Nurse Consultant role is a fully remote position designed for experienced registered nurses who thrive on clinical decision-making and structured review processes. The consultant plays a key role in reviewing precertification requests, applying evidence-based clinical guidelines, and ensuring the delivery of high-quality, cost-effective care. This role operates within a 24/7 utilization management environment.
Core Responsibilities and Focus Areas
Clinical Review and Decision Support
The nurse consultant applies critical thinking, clinical judgment, and established evidence-based criteria to review services requiring precertification. When appropriate, cases are escalated to a Medical Director for further review.
Utilization Management Operations
The role supports round-the-clock utilization management operations and adapts to rotating schedules that may include holidays and evenings.
Provider Collaboration and Information Review
Most of the work is performed at a desk and over the phone. The consultant collects, analyzes, and reviews clinical information from healthcare providers to support authorization decisions.
Digital Systems and Documentation
The consultant navigates multiple systems and applications while maintaining accurate documentation using tools such as Teams, Outlook, Word, and Excel.
Ideal Candidate Profile
This role suits registered nurses who are detail-oriented, confident in applying clinical guidelines, and comfortable working independently in a remote environment. Strong communication skills and the ability to manage multiple digital systems are essential.
Required Qualifications
- Active, current, and unrestricted Registered Nurse licensure in New Jersey or a compact RN license covering New Jersey.
- Minimum of three years of clinical nursing experience.
- At least two years of experience using computers, navigating multiple applications, and working with Microsoft Office tools.
- Availability to work rotating schedules as part of a 24/7 operation.
Preferred Experience
- Previous utilization management or prior authorization experience.
- Prior employment with a health plan or managed care organization.
Education Background
- An associate degree in Nursing is required.
- A Bachelor of Science in Nursing is preferred.
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Compensation and Benefits
This position offers a competitive hourly pay range of $34.92 to $74.78, based on experience, education, and location. In addition to base pay, the role may qualify for bonuses or short-term incentive programs.
CVS Health provides a comprehensive benefits package that supports physical, emotional, and financial wellness. Benefits may include affordable medical plans, a 401(k) with company match, employee stock purchase options, paid time off, flexible schedules, family leave, tuition assistance, wellness programs, confidential counseling, and financial coaching. Benefit eligibility may vary by role.
Application Details
The application window for this role is expected to remain open until December 31, 2025. CVS Health considers qualified applicants with arrest or conviction records in accordance with federal, state, and local laws. For more details about CVS Health remote jobs, visit the official careers page.
Equal Opportunity Statement
CVS Health is committed to fostering an inclusive workplace where every colleague feels valued, respected, and supported. The organization reflects the diverse communities it serves and continues to invest in people who fuel its future.