Remote Precertification Utilization Nurse Consultant

4004 Aetna Medicaid Administrators; Virginia (MN); Hybrid; USD 83,383,000 - 178,573,000; Full time

Benefits offered by this job

100% remote work

Virginia residency preference

Clinical impact in non-bedside role

Collaborative healthcare environment

Job summary

CVS Health is seeking a remote Utilization Management Nurse Consultant (RN Precertification) to join our team. The role focuses on reviewing and authorizing services using guidelines, coordinating with providers, and managing a high-volume caseload in a fully remote setting.

Preference is given to Virginia residents and candidates with Virginia and Compact RN licenses. A full-time schedule supports a stable, on-call friendly work pattern within a mission-driven healthcare environment.

Qualifications

• Active, unrestricted COMPACT RN license in state of residence.
• 3+ years of clinical nursing experience.
• Strong computer skills across multiple systems (EHRs, portals).
• Ability to work Monday–Friday, 8:00 AM–5:00 PM, with occasional weekend/holiday on-call.
• Associate's degree in Nursing required.

Responsibilities

• Review clinical information and authorization requests using evidence-based guidelines.
• Collaborate with healthcare providers to gather documentation.
• Approve services within scope or refer complex cases to Medical Director.
• Manage a high volume of cases in a phone- and computer-based environment.

Skills

Compact RN license

Clinical nursing

Computer skills

On-call availability

Education

Associate degree in Nursing

BSN (preferred)

Job description

CVS Health is seeking a remote Utilization Management Nurse Consultant (RN Precertification) to join our team. The role focuses on reviewing and authorizing services using guidelines, coordinating with providers, and managing a high-volume caseload in a fully remote setting.

Preference is given to Virginia residents and candidates with Virginia and Compact RN licenses. A full-time schedule supports a stable, on-call friendly work pattern within a mission-driven healthcare environment.