Utilization Management Nurse Consultant at CVS Health · Pittsburgh

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.

Registered Nurse (RN) – Utilization Management

Bring your clinical expertise beyond the bedside and help drive better healthcare outcomes. We’re looking for a skilled RN to join our Utilization Management team, ensuring members receive appropriate, high-quality care across the continuum.

What You’ll Do

• Review clinical documentation and apply guidelines to support coverage decisions
• Collaborate with providers and care teams to coordinate appropriate treatment
• Identify opportunities to improve quality, outcomes, and resource utilization
• Connect members to programs and services that support holistic care
• Provide clinical expertise to internal and external stakeholders

WHAT YOU BRING - REQUIRED

• Active, unrestricted RN license in your state of residence
• 2+ years of adult acute care or critical care experience
• Strong clinical judgment, communication, and multitasking skills
• Comfort working in a fast-paced, technology-driven environment

Preferred Qualifications

• Experience in Med-Surg or a specialty area
• Managed Care or Utilization Management experience
• Reside in Eastern or Central time zones

Work Environment & Schedule

• 24/7 operations with shifts that may include evenings, weekends, and holidays
• Sedentary, computer-based role requiring strong attention to detail and frequent communication

Education

• Associate’s Degree required
• BSN preferred

Anticipated Weekly Hours 40

Time Type Full time

Pay Range

The typical pay range for this role is:

$29.10 - $62.32

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 07/11/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.