Utilization Management Nurse Consultant

$32.01 - $68.55 / hour

Registered Nurse (RN) – Utilization Management

Join a dynamic healthcare team and make an impact on patient care from wherever you work.

We are seeking an experienced Registered Nurse (RN) to support our 24/7 Utilization Management operations. In this role, you will use your clinical expertise to review cases, assess medical necessity, coordinate care, and help ensure members receive appropriate, high-quality healthcare services.

What You'll Do

Review clinical information and apply evidence-based criteria to support coverage determinations and care recommendations.
Collaborate with providers, care teams, and internal partners to coordinate treatment and services.
Identify opportunities to improve healthcare quality, outcomes, and benefit utilization.
Refer members to appropriate programs and services that support their overall health needs.
Serve as a clinical resource for utilization and benefit management questions.

What We're Looking For

Required Qualifications

Active, unrestricted RN license in your state of residence.
2+ years of RN experience in an adult acute care or critical care setting.
Associate Degree in Nursing.
Strong communication, multitasking, and computer navigation skills.
Ability to work a designated schedule of 8:00 am to 5:00 PM ET, including weekends, holidays, and evening hours based on business needs.

Preferred Qualifications

BSN preferred.
Clinical experience in Med-Surg or a specialty area.
Managed Care and/or Utilization Management experience.
Candidates located in the Eastern Time Zone preferred.

Why Join Us?

Apply your clinical expertise in a collaborative, fast-paced environment.
Help improve healthcare outcomes for members across the continuum of care.
Work with a mission-driven team focused on quality, efficiency, and patient-centered care.

Ready to leverage your nursing experience in a rewarding Utilization Management role? Apply today.

Work from Home Requirements:

You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$32.01 - $68.55

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: 08/22/2026

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

Share this job

Related Jobs

Home Health

Full-time

1 month ago

Registered Nurse Case Manager – Field (Monmouth & Surrounding Counties, NJ)

CVS Health Tinton Falls, NJ

$66,575 - $142,576 / year

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 Case Manager – Field (Monmouth & Surrounding Counties, NJ) New Hire Bonus Available Make a Meaningful Impact in Your Community We’re looking for a compassionate and experienced Registered Nurse who enjoys working both independently and out in the community. In this role, you’ll help coordinate care for members with complex needs, supporting them in living safely and comfortably at home. This is primarily a field-based role with flexibility to work from home when not in the field, offering a great balance of independence and purpose-driven work. Travel & Work Schedule: Field-based role - Must possess reliable transportation and be willing and able to travel up to 75% of the time in your county of residence as well as the surrounding area’s. Mileage is reimbursed by our company expense reimbursement policy Most travel is daytime, local driving (generally within 60 minutes of your home base) No overnight travel required Travel is planned and scheduled in advance, with flexibility to help manage your day Standard schedule: Monday–Friday, 8:00 AM – 5:00 PM (no weekends or holidays required) If you enjoy getting out into the community and building relationships face-to-face, this role offers a dynamic and rewarding workday. What You’ll Do: Conduct in-home assessments with members enrolled in Managed Long-Term Services and Supports (MLTSS) programs Evaluate medical, behavioral, and social needs to support appropriate care and services Collaborate with providers, caregivers, and interdisciplinary teams to ensure coordinated, holistic care Develop and manage individualized care plans that promote safety, independence, and quality of life Participate in care team meetings and advocate for member needs Document all assessments and care activities accurately in the electronic health record Support members through care transitions and help connect them with community resources Mentor new team members as you grow in the role Required Qualifications: Active, unrestricted RN license in New Jersey At least 3 years of clinical experience (hospital, home health, ambulatory care, or similar settings) Residence in Monmouth County or nearby communities Comfort with frequent local travel and in-home visits Strong assessment, communication, and critical-thinking skills Successful completion of the NJ Choice Certification, including Minimum exam score of 80%, Completion of state training modules and Field mentoring component Ability to work independently and manage a flexible daily schedule Preferred Experience: Case management or care coordination Managed care environment Discharge planning or transition-of-care experience Crisis intervention skills Education: Associate’s degree in Nursing required (BSN preferred) Why Join CVS Health an Aetna Co? Meaningful work that directly improves members’ lives Autonomy and flexibility in your day-to-day schedule A supportive, team-oriented environment Opportunities for professional growth, including certification and mentoring Ready to take your nursing career beyond the bedside? Join us in delivering care where it matters most—right in your community. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00 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: 08/03/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Home Health

Full-time

3 months ago

Case Manager Registered Nurse - Field (Monmouth/Ocean) County, NJ

CVS Health Tinton Falls, NJ

$66,575 - $142,576 / year

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. Location: This role will be work at home with 25-50% travel within (Monmouth/Ocean) County, NJ. (50-mile radius from applicants’ home) Schedule: Standard business hours Monday-Friday 8:00am-5:00pm EST. Position Summary The ICM Case Manager develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. Our Mission Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have a life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in markets across the country. Our Integrated Care Management (ICM) Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Help us elevate our patient care to a whole new level! Key Responsibilities Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Remote Work Expectations This is a remote role with 25-50% travel required, candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications Minimum 3+ years of clinical practice experience. Must have active and unrestricted RN licensure in the state of NJ. Willing and able to travel 25-50% of their time using your own vehicle to meet members face to face in their assigned area. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy. The protection and security of our colleagues is paramount. CVS Health encourages it’s nurses to meet with members in a public place if they feel that is more appropriate. If needed, security escort is also available. Must reside close to or within (Monmouth/Ocean ) County, New Jersey. Preferred Qualifications Certified Case Manager is preferred. Minimum 2+ years Care Management, Discharge Planning and/or Home Health Care Coordination experience preferred. Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually. Excellent analytical and problem-solving skills. Effective communications, organizational, and interpersonal skills. Ability to work independently. Effective computer skills including navigating multiple systems and keyboarding. Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications. Bilingual Preferred. Education Associate's Degree required. Bachelor's degree preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00 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: 08/22/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Manager/Supervisor

Full-time

1 month ago

Acute Dialysis Services Program Manager - RN

Fresenius Medical Care Edison, NJ

$117,603 - $195,998 / year

PURPOSE AND SCOPE: Ensure the provision of quality patient care to all hospitalized patients in the most efficient manner in accordance with company policy. Provides direct supervision and coordination of inpatient staff. Responsible for high volume monthly treatments. Utilizes the FMC mission, core values and customer service philosophy to ensure quality service while maintaining a high level of efficiency management. PRINCIPAL DUTIES AND RESPONSIBILITIES: Manages the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, and staffing. Monitors costs/spending in all areas including medical supply inventory, personnel and accounts payable. Determines innovative ways to reduce costs and maintain quality. Ensures proper staffing and operations at all contracted facilities. Ensures efficient staff/ patient scheduling and efficient staffing utilization following company policy while maintaining a safe environment. Provides leadership, coaching and development plans for all direct reports to maintain an engaged and productive workforce; partnering with Human Resources on employee matters. Acts as an advisor to subordinate(s) to meet schedules and/or resolve technical problems. Responsible for hiring, coaching and counseling employees, including performance reviews, development, disciplinary action and terminations. Technically proficient in the specific department and knowledge of industry practice and business principles. Works on issues of diverse scope where analysis of situation or data requires evaluation of a variety of factors, including an understanding of current business trends. Reviews profit and loss statements for greater understanding of specific department performance. Responsible for Acute Care Electronic System (ACES) include the following: Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner. Collaborates with contracted facility representatives to maintain a state of survey readiness for internal and external agency surveys. Works with contracted facility (ies) to resolve specific department issues as suggested/directed as a result of a survey. Maintains and prepares QAI data and presentations. Participates and presents at meetings with internal and external representatives, often leading a collaborative effort among members of a project team. Assures provision of facility specific QAI information as appropriate. Interacts with internal departments and external customers; particularly in problem resolution and acting as the industry expert on behalf of the customer. Ensures compliance with hospital regulations and participates in surveys conducted by TJC, CMS, OSHA and other agencies. Ensures a proper orientation and training program for all clinical and technical staff. Ensures that continuing in-services are provided to all clinical and technical staff. Maintain documentation of all training. Conducts and documents acute staff meetings on a regular basis. Ensures provision of dialysis and related services such as hemoperfusion, apheresis, continuous renal replacement therapies, peritoneal dialysis, and UF complete if contracted to do so. Ensures that treatment information is documented appropriately by staff performing treatments and oversees billing for services performed is timely and accurate. If appropriately licensed, performs treatments as necessary to assist in times of high census, staffing shortages, and/or to assist with managing staffing costs as appropriate. Confers routinely with Technical Program Manager and Technical Operations Manager to ensure preventative maintenance program for routine machine maintenance, to ensure the timely repair of disabled machines, to coordinate infection control measures, routine culturing, water testing, logging of results, transportation of equipment and supplies and communicate technical information to the staff. Ensures all acute treatments are performed in contracted hospitals according to the established policies and procedures and in compliance with all applicable regulatory requirements. Ensures efficient utilization of supplies and equipment. Assists with various projects as assigned. Performs other duties as assigned. PHYSICAL DEMANDS AND WORKING CONDITIONS : The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Availability for night and weekend calls/troubleshooting may be necessary to oversee issues as they arise with management of a 24/7/365 service. Day to day work includes desk and personal computer work and interaction with patients, facility staff and physicians. The position requires travel between assigned facilities and various locations within the community. Travel to regional, Business Unit and Corporate meetings may be required. The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. Could possibly be exposed to infectious and contagious diseases/materials. SUPERVISION: May be responsible for the direct supervision of various levels of inpatient staff as designated by region. EDUCATION AND REQUIRED CREDENTIALS: Graduate of an accredited School of Nursing (RN); Advanced degree desirable Current state licensure as applicable EXPERIENCE AND SKILLS : 3-5 years’ related experience. 3+ years’ supervisory or project/program management experience preferred. The rate of pay for this position will depend on the successful candidate’s work location and qualifications, including relevant education, work experience, skills, and competencies. Rate: $117,603.00-$195,998.00 Non-Bonus Eligible Positions: include language below. Benefit Overview: This position offers a comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave. Bonus Eligible Positions – include language below. Benefit Overview: This position offers a comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave and potential for performance-based bonuses depending on company and individual performance. Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws. Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sexual orientation, gender identity, parental status, national origin, age, disability, military service, or other non-merit-based factors

Hospice

Full-time

1 month ago

Registered Nurse, Hospice PRN

AccentCare, Inc. Edison, NJ

$45 - $50 / hour

Overview Hospice Registered Nurse (RN) Pay : $45.00 - $50.00/ per hour, based on experience Benefits : Medical, dental, vision, PTO, paid holidays, 401(k), and more! Schedule : PRN 1-2 Shifts per week Including Saturday and Sunday (Every Other Weekend) 8am -5pm Coverage Area :Middlesex, Monmouth, and Ocean counties Find your purpose while bringing comfort and dignity to hospice patients and their loved ones during life’s most delicate moments. As a Hospice Registered Nurse (RN) , you’ll work at the center of an interdisciplinary care team, building trusted relationships with patients, families, physicians, and teammates. You’ll have the autonomy to practice at the top of your license—while being fully supported by a mission‑driven organization that truly cares for you. What You Need to Know Hospice Registered Nurse (RN) Responsibilities Provide individualized nursing care that maximizes comfort and quality of life Partner with patients, families, physicians, and the interdisciplinary group to create and carry out care plans Perform comprehensive assessments—physical, emotional, social, and spiritual—to guide care decisions Educate and support patients and caregivers, meeting them where they are Coordinate care across disciplines to ensure continuity and dignity Document care clearly and accurately to reflect patient needs and progress Participate in on‑call or admission rotations as needed Engage in ongoing learning and professional development Hospice Registered Nurse (RN) Qualifications Registered Nurse (RN) license in the state of practice At least one year of nursing experience Reliable transportation, valid driver’s license, and appropriate auto insurance You can find success in this role if you’ve held the following positions: Hospice Registered Nurse, Home Health Registered Nurse, Palliative Care Nurse, Med‑Surg Registered Nurse, Oncology Nurse, Geriatric Nurse, Field Nurse, Visiting Nurse, Admissions Nurse, Patient Care Nurse, RN Care Coordinator, or Clinical Nurse in acute care, home health, or community‑based settings. Our Investment in You Caring for others starts with caring for you. We’re committed to fostering a purpose-driven workplace where you feel supported, and that means prioritizing your physical, financial, and mental well-being. Our benefits include: Medical, dental, and vision coverage Paid time off and paid holidays 401(k) Flexible spending and health savings accounts Wellness offers, including an employee assistance program, pet insurance, and access to Calm, a meditation, sleep, and relaxation app Company store credit for your first AccentCare-branded scrubs for patient-facing employees And more! Why AccentCare? Come as you are! At AccentCare, you’re part of a community that cares — for patients and each other. You can rest assured we offer equal employment opportunities regardless of race, ethnicity, sex, sexual orientation, gender identity, religion, national origin, age, or disability.

Hospice

Full-time

1 month ago

Registered Nurse, Hospice (Weekends)

AccentCare, Inc. Edison, NJ

$45 - $50 / hour

Overview Hospice Registered Nurse (RN) Pay : $45.00 - $50.00/ hr, based on experience Schedule : Every Other Weekend Saturday & Sunday 8am -5pm Coverage Area :Middlesex, Monmouth, and Ocean counties Find your purpose while bringing comfort and dignity to hospice patients and their loved ones during life’s most delicate moments. As a Hospice Registered Nurse (RN) , you’ll work at the center of an interdisciplinary care team, building trusted relationships with patients, families, physicians, and teammates. You’ll have the autonomy to practice at the top of your license—while being fully supported by a mission‑driven organization that truly cares for you. What You Need to Know Hospice Registered Nurse (RN) Responsibilities Provide individualized nursing care that maximizes comfort and quality of life Partner with patients, families, physicians, and the interdisciplinary group to create and carry out care plans Perform comprehensive assessments—physical, emotional, social, and spiritual—to guide care decisions Educate and support patients and caregivers, meeting them where they are Coordinate care across disciplines to ensure continuity and dignity Document care clearly and accurately to reflect patient needs and progress Participate in on‑call or admission rotations as needed Engage in ongoing learning and professional development Hospice Registered Nurse (RN) Qualifications Registered Nurse (RN) license in the state of practice At least one year of nursing experience Reliable transportation, valid driver’s license, and appropriate auto insurance You can find success in this role if you’ve held the following positions: Hospice Registered Nurse, Home Health Registered Nurse, Palliative Care Nurse, Med‑Surg Registered Nurse, Oncology Nurse, Geriatric Nurse, Field Nurse, Visiting Nurse, Admissions Nurse, Patient Care Nurse, RN Care Coordinator, or Clinical Nurse in acute care, home health, or community‑based settings. Our Investment in You Caring for others starts with caring for you. We’re committed to fostering a purpose-driven workplace where you feel supported, and that means prioritizing your physical, financial, and mental well-being. Our benefits include: Medical, dental, and vision coverage Paid time off and paid holidays 401(k) Flexible spending and health savings accounts Wellness offers, including an employee assistance program, pet insurance, and access to Calm, a meditation, sleep, and relaxation app Company store credit for your first AccentCare-branded scrubs for patient-facing employees And more! Why AccentCare? Come as you are! At AccentCare, you’re part of a community that cares — for patients and each other. You can rest assured we offer equal employment opportunities regardless of race, ethnicity, sex, sexual orientation, gender identity, religion, national origin, age, or disability.