{"version":"0.1","company":{"name":"YubHub","url":"https://yubhub.co","jobsUrl":"https://yubhub.co/jobs/city/est-and-or-cst/"},"x-facet":{"type":"city","slug":"est-and-or-cst","display":"Est And/or Cst","count":1},"x-feed-size-limit":100,"x-feed-sort":"enriched_at desc","x-feed-notice":"This feed contains at most 100 jobs (the most recently enriched). For the full corpus, use the paginated /stats/by-facet endpoint or /search.","x-generator":"yubhub-xml-generator","x-rights":"Free to redistribute with attribution: \"Data by YubHub (https://yubhub.co)\"","x-schema":"Each entry in `jobs` follows https://schema.org/JobPosting. YubHub-native raw fields carry `x-` prefix.","jobs":[{"@context":"https://schema.org","@type":"JobPosting","identifier":{"@type":"PropertyValue","name":"YubHub","value":"job_7458a0c0-5fa"},"title":"Utilization Management Nurse Consultant","description":"<p>We&#39;re building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience. At CVS Health, you&#39;ll be surrounded by colleagues who care deeply, innovate with purpose, hold themselves accountable, and prioritize safety and quality in everything they do.</p>\n<p><strong>Job Summary:</strong> As a Utilization Management Nurse Consultant, you will utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.</p>\n<p><strong>Responsibilities:</strong></p>\n<ul>\n<li>Gather clinical information and apply clinical criteria/guidelines, policies, procedures, and clinical judgment to render coverage determinations/recommendations along the continuum of care.</li>\n<li>Communicate with providers and other parties to facilitate care/treatment.</li>\n<li>Identify members for referral opportunities to integrate with other products, services, and programs.</li>\n<li>Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.</li>\n<li>Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.</li>\n</ul>\n<p><strong>Requirements:</strong></p>\n<ul>\n<li>2+ years of experience as a Registered Nurse in an adult acute care/critical care setting.</li>\n<li>Active current and unrestricted RN licensure in the state of residence.</li>\n<li>Must reside in EST or CST.</li>\n<li>Utilization Management is a 24/7 operation, and work schedules will include weekends, holidays, and evening hours.</li>\n</ul>\n<p><strong>Technical and Logistical Requirements:</strong></p>\n<ul>\n<li>Device &amp; System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.</li>\n<li>Communication Tools: Ability to communicate on digital channels such as email, calendar invites, Teams messaging, and virtual meetings.</li>\n<li>Collaboration &amp; Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).</li>\n<li>Systems Access &amp; Security: Ability to log in to secure systems, manage strong passwords, and recognize suspicious emails or links.</li>\n<li>Troubleshooting &amp; Support: Ability to resolve common technical issues independently.</li>\n</ul>\n<p><strong>Work from Home Requirements:</strong></p>\n<ul>\n<li>Direct/hardwired internet connection to a modem/router within 7 feet of the computer.</li>\n<li>Quiet, secure, and private designated home virtual work location.</li>\n<li>Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.</li>\n</ul>\n<p><strong>Preferred Qualifications:</strong></p>\n<ul>\n<li>2+ years of clinical experience in med surg or specialty area.</li>\n<li>Managed Care experience preferred, especially Utilization Management.</li>\n</ul>\n<p><strong>Education:</strong></p>\n<ul>\n<li>Associate&#39;s Degree required.</li>\n<li>BSN preferred.</li>\n</ul>\n<p><strong>Anticipated Weekly Hours:</strong> 40</p>\n<p><strong>Pay Range:</strong> $29.10 - $62.32</p>\n<p style=\"margin-top:24px;font-size:13px;color:#666;\">Job Data by <a href=\"https://yubhub.co\">YubHub</a>.</p>","url":"https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/TX---Work-from-home/Utilization-Management-Nurse-Consultant---Work-at-Home-EST---CST_R1075910","directApply":true,"hiringOrganization":{"@type":"Organization","name":"CVS Health","sameAs":"https://cvshealth.com/","logo":"https://logos.yubhub.co/cvshealth.com.png"},"x-apply-url":"https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/TX---Work-from-home/Utilization-Management-Nurse-Consultant---Work-at-Home-EST---CST_R1075910","x-work-arrangement":"remote","x-experience-level":"senior","x-job-type":"full-time","x-salary-range":"$29.10 - $62.32","x-skills-required":["RN licensure","clinical experience","Microsoft Office 365","digital communication tools"],"x-skills-preferred":["Managed Care experience","Utilization Management experience","BSN degree"],"x-benefits":["dental"],"x-licences":["RN licence"],"x-visa-sponsorship":"unknown","x-visa-sponsorship-text":null,"x-work-authorisation":"unknown","x-work-authorisation-text":null,"datePosted":"2026-10-16T00:00:00.000Z","jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"EST and/or CST"}},"jobLocationType":"TELECOMMUTE","employmentType":"FULL_TIME","occupationalCategory":"Healthcare","industry":"Healthcare","skills":"RN licensure, clinical experience, Microsoft Office 365, digital communication tools, Managed Care experience, Utilization Management experience, BSN degree"}]}