Remote Florida Utilization Management Nurse Consultant

CVS Health; Fort Lauderdale (FL); Remote; USD 40,000 - 86,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Florida is seeking a Utilization Management Nurse Consultant. This full-time remote (work from home in Florida) role requires an active Florida RN license and at least 3 years of inpatient nursing experience.

You will review medical necessity, coordinate care, and support providers to ensure appropriate, cost-effective outcomes. The position involves 24/7 operations with evenings, weekends, and holidays.

Qualifications

• Active, unrestricted RN license in Florida.
• Minimum of 3 years inpatient clinical nursing experience.
• Willingness to obtain additional state licenses as needed.

Responsibilities

• Review clinical documentation and apply medical necessity criteria to determine coverage.
• Coordinate utilization and benefit management across the care continuum.
• Collaborate with providers and care teams to plan discharge and transitions.
• Use clinical judgment to support evidence-based care and resource use.
• Identify members for care management and facilitate referrals.
• Support urgent member needs, including triage when necessary.
• Serve as a clinical resource on utilization management processes.
• Promote quality improvement to enhance outcomes and utilization.

Skills

Clinical assessment

Documentation

Communication

Critical thinking

Education

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Job description

CVS Health in Florida is seeking a Utilization Management Nurse Consultant. This full-time remote (work from home in Florida) role requires an active Florida RN license and at least 3 years of inpatient nursing experience.

You will review medical necessity, coordinate care, and support providers to ensure appropriate, cost-effective outcomes. The position involves 24/7 operations with evenings, weekends, and holidays.