Utilization Management Nurse Consultant – Medicaid Program, Multiple Locations

R0796108 At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary We are seeking a detail‑oriented and dedicated Registered Nurse to support our Medical Management team. In this role, you’ll play an essential part in ensuring members receive timely and accurate communication regarding their healthcare services. You’ll be responsible for composing and auditing approval, extension, and denial letters that meet regulatory, accreditation, and quality standards. Limited phone time. This position supports the overall effectiveness of our medical management programs by promoting clear communication, maintaining precise documentation, and helping ensure members receive high‑quality, appropriate care. If you enjoy a balance of clinical knowledge, writing, and administrative coordination, this role offers an excellent opportunity to apply your skills in a meaningful way.

Key Responsibilities

• Create, review, and audit medical determination letters including approvals, extensions, and denials
• Ensure all documentation meets regulatory, accreditation, and internal quality standards
• Support effective medical management by facilitating clear communication across internal teams and external partners
• Maintain accurate, complete records for compliance and risk‑management requirements
• Contribute to overall quality and effectiveness of healthcare services through attention to detail and process consistency

Required Qualifications

• Registered Nurse (RN) with an active, unrestricted license in the state of residence
• 1+ year of clinical nursing experience

Schedule: Thursday–Saturday, 9:00 AM–8:00 PM EST

Preferred Qualifications

• Experience in Utilization Management or Managed Care
• Strong grammar, writing, and editing skills
• Ability to multi‑task and work efficiently in a fast‑paced environment

Education

• Associate or Bachelor’s degree in Nursing

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $56.14 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 01/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job Apply To this Job