Remote RN: Utilization & Care Optimization Consultant

CVS Health; Hawaii; Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Job summary

CVS Health seeks an Utilization Management Nurse Consultant (Medicare) to review clinical cases and ensure members receive appropriate care. The remote, full-time role follows a weekday schedule and leverages clinical expertise beyond the bedside.

You will collaborate with providers, coordinate treatment, and support utilization decisions while working within a 40-hour week and CVS Health guidelines. Eligible for comprehensive benefits based on eligibility.

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-6:00 PM in your time zone. Utilization Management is 24/7; holidays and evening hours included

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

RN experience 3+ years

Med/Surg experience

Clinical assessment

Microsoft Office

Weekday schedule

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office

Job description

CVS Health seeks an Utilization Management Nurse Consultant (Medicare) to review clinical cases and ensure members receive appropriate care. The remote, full-time role follows a weekday schedule and leverages clinical expertise beyond the bedside.

You will collaborate with providers, coordinate treatment, and support utilization decisions while working within a 40-hour week and CVS Health guidelines. Eligible for comprehensive benefits based on eligibility.