Remote RN: Utilization Management Consultant

CVS Health; Guin (AL); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations and care coordination. This remote, full-time role requires an active RN license and 3+ years of nursing experience, including Med/Surg.

After a training period, the schedule shifts to a 4-day weekend pattern (Friday–Monday, 10-hour shifts) with occasional evenings and holidays; proficiency in Microsoft Office is essential, and prior authorization or UM experience is

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office.
• Willingness to work required schedule post-training.

Responsibilities

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines, policies, and sound judgment across the care continuum.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to enhance quality, efficiency, and member outcomes.
• Refer members to additional programs and services as appropriate.
• Serve as a clinical resource within utilization/benefit management.

Skills

RN experience

Attention to detail

Healthcare knowledge

Education

Associate's degree or BSN preferred

Tools

Microsoft Office (Outlook/Teams/Excel)

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations and care coordination. This remote, full-time role requires an active RN license and 3+ years of nursing experience, including Med/Surg.

After a training period, the schedule shifts to a 4-day weekend pattern (Friday–Monday, 10-hour shifts) with occasional evenings and holidays; proficiency in Microsoft Office is essential, and prior authorization or UM experience is