Remote Medicare Utilization Nurse Consultant

CVS Health; Montana City (MT); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Benefits package

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant (Clinical Precertification RN) for a remote, full-time weekday schedule. The RN will review clinical cases, determine coverage, and coordinate care using evidence-based guidelines.

This is a 40-hour week with potential holidays and evening hours in a 24/7 operation, requiring strong clinical judgment. Ideal candidates hold an active RN license, 3+ years of experience (1+ year in Med/Surg), and an Associate Degree in Nursing.

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.
• Associates Degree in Nursing required.

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

Microsoft Office

Education

Associate Degree in Nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking an Utilization Management Nurse Consultant (Clinical Precertification RN) for a remote, full-time weekday schedule. The RN will review clinical cases, determine coverage, and coordinate care using evidence-based guidelines.

This is a 40-hour week with potential holidays and evening hours in a 24/7 operation, requiring strong clinical judgment. Ideal candidates hold an active RN license, 3+ years of experience (1+ year in Med/Surg), and an Associate Degree in Nursing.