Remote Medicare Utilization Management RN

CVS Health; Bozeman (MT); Remote; USD 36,000 - 85,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant for Medicare precertifications. This remote, full‑time role supports weekday scheduling and requires an active RN license and 3+ years of nursing experience, including Med/Surg.

You will review cases, coordinate care, and apply clinical judgment to ensure appropriate treatment. Ideal candidates bring strong assessment skills, proficiency with Microsoft Office, and the ability to work Monday–Friday, 9:00 AM–6:00 PM in their time

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.

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

Clinical assessment

Decision making

Microsoft Office

Tools

Microsoft Office

Job description

CVS Health is seeking a Utilization Management Nurse Consultant for Medicare precertifications. This remote, full‑time role supports weekday scheduling and requires an active RN license and 3+ years of nursing experience, including Med/Surg.

You will review cases, coordinate care, and apply clinical judgment to ensure appropriate treatment. Ideal candidates bring strong assessment skills, proficiency with Microsoft Office, and the ability to work Monday–Friday, 9:00 AM–6:00 PM in their time