Remote Clinical Precertification RN Consultant

CVS Health; Orangeburg (SC); Remote; USD 36,000 - 86,000; 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 an Utilization Management Nurse Consultant to work remotely in a full-time weekday schedule. You will review cases, determine coverage, coordinate treatment with care teams, and apply clinical judgment to support utilization decisions.

The role emphasizes leveraging evidence-based guidelines, collaborating with providers, and serving as a clinical resource across stakeholders. A valid RN license and a nursing degree are required.

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; holidays/evening hours may be required.
• 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

RN license

RN experience

Clinical assessment

MS Office

Flexible schedule

shift flexibility

Education

Associate Degree in Nursing

BSN preferred

Tools

MedCompass

Microsoft Office 365

Job description

CVS Health is seeking an Utilization Management Nurse Consultant to work remotely in a full-time weekday schedule. You will review cases, determine coverage, coordinate treatment with care teams, and apply clinical judgment to support utilization decisions.

The role emphasizes leveraging evidence-based guidelines, collaborating with providers, and serving as a clinical resource across stakeholders. A valid RN license and a nursing degree are required.