Remote Medicare Utilization Nurse Consultant

CVS Health; Bristol (RI); Remote; USD 36,000 - 86,000; Full time

Job summary

CVS Health is seeking an experienced Utilization Management Nurse Consultant (Medicare) to review cases and guide care decisions from a remote setting. The role emphasizes collaboration with providers, evidence-based determinations, and ensuring appropriate care timing.

You’ll bring an active RN license, 3+ years of RN experience including Med/Surg, and strong clinical judgment. This full-time position requires weekday hours with occasional holiday/evening coverage.

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–6:00pm 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

RN license

Clinical assessment

Decision making

Microsoft Office

Education

Associate Degree in Nursing

Tools

Microsoft Office 365

Excel

Teams

Job description

CVS Health is seeking an experienced Utilization Management Nurse Consultant (Medicare) to review cases and guide care decisions from a remote setting. The role emphasizes collaboration with providers, evidence-based determinations, and ensuring appropriate care timing.

You’ll bring an active RN license, 3+ years of RN experience including Med/Surg, and strong clinical judgment. This full-time position requires weekday hours with occasional holiday/evening coverage.