Utilization Management Nurse Consultant - Weekends 10-Hour Shifts

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.

Remote Utilization Management RN (Prior Authorization) Full-Time | Remote | Weekend Schedule We’re seeking an experienced Registered Nurse (RN) to join our Utilization Management team in a fully remote role. This position is ideal for nurses who enjoy applying clinical judgment, working collaboratively with providers, and influencing quality healthcare decisions—without bedside demands. Schedule: Saturday & Sunday (CST) with flexible consecutive weekdays to meet business needs 10-hour shifts after training Must be available Monday–Friday during business hours for training UM operates 24/7, with potential evenings, holidays, or on-call coverage

Review clinical documentation and apply evidence-based criteria to authorize services or escalate cases to a Medical Director Communicate with providers to gather information and facilitate timely care Support appropriate utilization of healthcare benefits across the continuum of care Identify opportunities for referrals, care coordination, and quality improvement Collaborate with internal and external partners in utilization and benefit management