Remote Medicare Utilization RN Consultant

CVS Health; Honolulu (HI); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. This full‑time role requires RN licensure in the state of residence and 3+ years of RN experience, including Med/Surg, with proficiency in Microsoft Office.

The position supports a 40-hour work week, with a schedule that includes holidays and evenings, and remote work within the U.S. The role focuses on assessing care options, applying clinical criteria, and coordinating with providers to ensure

Qualifications

• Active RN license in state of residence.
• ~3+ years of RN experience.
• ~1+ years of Med/Surg experience.
• ~1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply criteria/guidelines to render coverage determinations.
• Communicate with providers to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other programs.
• Consult with internal/external constituents in the coordination of utilization/benefit management.

Skills

RN experience

Active RN license

Med/Surg experience

MS Office experience

Education

Associate degree

BSN preferred

Tools

MedCompass

Microsoft Office Suite

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. This full‑time role requires RN licensure in the state of residence and 3+ years of RN experience, including Med/Surg, with proficiency in Microsoft Office.

The position supports a 40-hour work week, with a schedule that includes holidays and evenings, and remote work within the U.S. The role focuses on assessing care options, applying clinical criteria, and coordinating with providers to ensure