Remote RN Utilization Management Consultant

CVS Health; Little Elm (TX); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role supports coordination of care, uses clinical criteria to render coverage recommendations, and communicates with providers to ensure appropriate services for members.

The position requires ~3+ years as an RN with active licensure, Med/Surg experience, and proficiency in MS Office. Schedule is Monday–Friday, with potential holidays and evenings, and a home-based work setup per CVS Health guidelines.

Qualifications

• Must be an RN with active current and unrestricted licensure in the state of residence.
• 3+ years of RN experience required, with Med/Surg exposure.
• Proficient with Microsoft Office applications (Outlook, Teams, Excel).

Responsibilities

• Assess, plan, implement and coordinate care to facilitate appropriate services for members.
• Gather clinical information and apply guidelines to determine coverage decisions.
• Communicate with providers to facilitate care and identify referral opportunities.
• Collaborate with internal and external stakeholders in utilization/benefit management.

Skills

Registered Nurse

Med/Surg experience

RN licensure (active)

Microsoft Office

Education

Associates degree

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role supports coordination of care, uses clinical criteria to render coverage recommendations, and communicates with providers to ensure appropriate services for members.

The position requires ~3+ years as an RN with active licensure, Med/Surg experience, and proficiency in MS Office. Schedule is Monday–Friday, with potential holidays and evenings, and a home-based work setup per CVS Health guidelines.