Remote RN Utilization Management Consultant

CVS Health Corporation; Austin (TX); Remote; USD 54,000 - 143,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking an RN Utilization Management Nurse Consultant. This 100% remote role coordinates utilization/benefit management and ensures medical necessity while promoting safe, cost-effective patient care.

The ideal candidate holds an active RN license, 2+ years of acute hospital experience, and familiarity with medical terminology and digital tools. The position includes a competitive benefits package.

Qualifications

• RN with active, unrestricted license required.
• 2+ years of acute hospital RN experience (medical-surgical/ICU preferred).
• Strong problem solving, decision making and ethical judgment required.
• Familiarity with medical terminology and digital literacy is expected.

Responsibilities

• Drive utilization management to ensure appropriate, cost-effective care.
• Conduct routine utilization reviews using evidence-based criteria.
• Collaborate with providers and payers to optimize patient outcomes.
• Coordinate and document utilization/benefit management activities.

Skills

Problem solving

Decision making

Medical terminology

Digital literacy

Customer service

Ethical handling

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is seeking an RN Utilization Management Nurse Consultant. This 100% remote role coordinates utilization/benefit management and ensures medical necessity while promoting safe, cost-effective patient care.

The ideal candidate holds an active RN license, 2+ years of acute hospital experience, and familiarity with medical terminology and digital tools. The position includes a competitive benefits package.