Job Overview: CVS Health is seeking a dedicated Utilization Management Nurse Consultant to join our dynamic team in a fully remote capacity. In this critical role, you will apply your clinical nursing expertise to assess and authorize healthcare services, ensuring optimal patient outcomes while managing costs effectively for our members across various health plans. Key Responsibilities: Conduct thorough clinical reviews of member cases, including inpatient admissions, outpatient procedures, and durable medical equipment requests. Collaborate with physicians, providers, and internal teams to gather necessary information and make timely authorization decisions based on evidence-based guidelines and medical necessity criteria. Document all reviews accurately in our proprietary systems, escalating complex cases as needed. Monitor ongoing care to prevent unnecessary utilization, promote quality care, and identify opportunities for care coordination. Stay current with regulatory changes, CMS guidelines, and industry best practices to support compliant decision-making. Provide education and feedback to providers on utilization management processes and alternatives to high-cost services. Required Qualifications: Active, unrestricted RN license in good standing; minimum of 3-5 years of recent clinical nursing experience, preferably in utilization review, case management, or acute care settings. Strong knowledge of medical terminology, anatomy, physiology, and common disease processes. Proficiency with electronic health records (EHR) and utilization management software. Excellent communication skills, both verbal and written, with the ability to interact professionally with diverse stakeholders. Ability to work independently in a remote environment while meeting strict turnaround times and productivity standards. Skills: Critical thinking and clinical judgment for accurate assessments; detail-oriented with strong organizational abilities; empathy and patient advocacy focus; advanced computer literacy including Microsoft Office Suite; familiarity with InterQual or Milliman Care Guidelines is highly preferred. Effective time management to handle high-volume caseloads efficiently. Company Info: CVS Health, a Fortune 10 company, is a leading healthcare innovator committed to making quality care more accessible, affordable, and convenient. With over 300,000 colleagues, we operate the nation's largest pharmacy chain, MinuteClinic locations, and advanced health services including Aetna insurance. Our mission drives us to transform health care through technology, data analytics, and compassionate service. Benefits: Enjoy competitive pay, comprehensive medical, dental, and vision coverage starting day one, plus prescription discounts. Receive 401(k) with company match, paid time off, holidays, and volunteer time. Access tuition reimbursement, employee stock purchase plans, and wellness programs including gym discounts and mental health support. Fully remote setup includes home office stipend and top-tier technology. Growth Opportunities: Advance your career with CVS Health's robust professional development programs, including certifications in case management (CM, ACM), leadership training, and mentorship. Opportunities to move into senior consultant roles, management, or specialized areas like behavioral health or pharmacy utilization. We foster internal mobility across our expansive network, with clear paths for promotion based on performance.