Remote Medicare Utilization Nurse Consultant

CVS Health; Austin (TX); On-site; USD 36,000 - 86,000; Full time

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN, Medicare) to review clinical cases and determine coverage using evidence-based guidelines in a remote, full-time weekday schedule.

You will collaborate with providers and care teams, applying clinical judgment to support utilization and benefit management decisions while identifying opportunities to improve care quality and member outcomes.

Qualifications

• Active, unrestricted RN license in home state.
• 3+ years RN experience, including 1+ year in Med/Surg.
• Strong clinical assessment and decision-making skills.
• Proficient with Microsoft Office (Outlook, Teams, Excel).
• 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

Med/Surg experience

Clinical assessment

Microsoft Office

Schedule (Mon–Fri 9–6)

ASN/ADN

Education

Associate Degree in Nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN, Medicare) to review clinical cases and determine coverage using evidence-based guidelines in a remote, full-time weekday schedule.

You will collaborate with providers and care teams, applying clinical judgment to support utilization and benefit management decisions while identifying opportunities to improve care quality and member outcomes.