Medicare Utilization Nurse Consultant — Remote

CVS Health; Salem (NH); Remote; USD 30,000 - 42,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a remote Utilization Management Nurse Consultant to review cases, determine coverage, and coordinate care. You’ll bring RN licensure, 3+ years of experience, including Med/Surg, and work a Monday–Friday schedule in your time zone.

This role emphasizes applying clinical judgment, collaborating with providers, and supporting quality outcomes within a 24/7 operation context. A strong foundation in nursing and proficiency with Office tools are essential.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years of RN experience, including 1+ year in Med/Surg.
• Strong clinical assessment and decision-making skills.
• Experience with Microsoft Office (Outlook, Teams, Excel).
• Ability to work Monday–Friday, 9:00 AM–6:00 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours.
• Associate Degree in Nursing.

Responsibilities

• Review clinical cases and make coverage determinations using evidence-based guidelines.
• Collaborate with providers and care teams to coordinate appropriate treatment.
• Apply clinical judgment to support utilization and benefit management decisions.
• Identify opportunities to improve care quality and member outcomes.
• Serve as a clinical resource across internal and external stakeholders.

Skills

Clinical assessment

Decision making

Communication

Education

Associate Degree in Nursing

Tools

Microsoft Office

Job description

CVS Health is seeking a remote Utilization Management Nurse Consultant to review cases, determine coverage, and coordinate care. You’ll bring RN licensure, 3+ years of experience, including Med/Surg, and work a Monday–Friday schedule in your time zone.

This role emphasizes applying clinical judgment, collaborating with providers, and supporting quality outcomes within a 24/7 operation context. A strong foundation in nursing and proficiency with Office tools are essential.