Remote RN Utilization Management Consultant

CVS Health; North Carolina; Hybrid; USD 36,000 - 85,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join a remote, full-time role with a weekend schedule. You will review clinical data to support coverage determinations, apply guidelines, and coordinate patient care with providers.

Strong MS Office skills and at least 3 years RN experience are required. The position offers a team-focused environment, competitive pay in a 24/7 operation, and opportunities to impact patient outcomes while

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).
• 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 license

RN experience

Med/Surg experience

Microsoft Office

Schedule commitment

Education

BSN preferred

Associate's required

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join a remote, full-time role with a weekend schedule. You will review clinical data to support coverage determinations, apply guidelines, and coordinate patient care with providers.

Strong MS Office skills and at least 3 years RN experience are required. The position offers a team-focused environment, competitive pay in a 24/7 operation, and opportunities to impact patient outcomes while