Remote Precertification UM RN Consultant

CVS Health; Nevada; Remote; USD 40,000 - 86,000; Full time

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant – Clinical Precertification RN (Medicare) for a remote, full-time role. You will collaborate with providers and care teams to ensure appropriate care, apply clinical judgment to decisions, and support quality outcomes while serving as a trusted resource for stakeholders.

The position requires an active RN license, 3+ years of RN experience (1+ year in Medical‑Surgical), and familiarity with UM platforms like MedCompass.

Qualifications

• Active, unrestricted RN license in the state of residence.
• Minimum 3 years of RN experience, including at least 1 year in Medical‑Surgical Nursing.
• Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel.
• Associate Degree in Nursing (ADN).
• Bachelor of Science in Nursing (BSN).
• Ability to work Monday-Friday, 9:00 AM-5:30 PM in your local time zone.
• Note: Utilization Management is a 24/7 operation; schedules may include evenings, weekends, and holidays.
• Utilization Management, Prior Authorization, or Care Management experience.
• Managed care experience.
• Experience using MedCompass or similar UM platforms.
• Ambulatory surgery or outpatient clinical experience.

Responsibilities

• Collaborate with providers and interdisciplinary care teams to support treatment planning.
• Apply clinical judgment to utilization management and prior authorization decisions.
• Identify opportunities to improve quality, outcomes, and member experience.
• Serve as a trusted clinical resource for internal and external stakeholders.

Skills

RN experience

Medical‑Surgical Nursing

Utilization management

Care management

Ambulatory/outpatient care

Education

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Tools

Microsoft Office (Outlook, Teams, Excel)

MedCompass or similar UM platforms

VPNs and healthcare applications

Job description

CVS Health is seeking an Utilization Management Nurse Consultant – Clinical Precertification RN (Medicare) for a remote, full-time role. You will collaborate with providers and care teams to ensure appropriate care, apply clinical judgment to decisions, and support quality outcomes while serving as a trusted resource for stakeholders.

The position requires an active RN license, 3+ years of RN experience (1+ year in Medical‑Surgical), and familiarity with UM platforms like MedCompass.