Remote RN: Utilization Management Consultant

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plans

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to work remotely on a full-time weekend schedule after training. This role focuses on ensuring members receive the right care at the right time by reviewing clinical information and applying guidelines.

4‑day weekend shifts, 10‑hour days, with occasional holidays in a 24/7 operation. The ideal candidate holds an active RN license, has 3+ years experience, and is proficient in Microsoft Office.

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 experience

RN license

Med/Surg experience

Microsoft Office

Education

Associate’s degree / BSN preferred

Tools

MedCompass

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to work remotely on a full-time weekend schedule after training. This role focuses on ensuring members receive the right care at the right time by reviewing clinical information and applying guidelines.

4‑day weekend shifts, 10‑hour days, with occasional holidays in a 24/7 operation. The ideal candidate holds an active RN license, has 3+ years experience, and is proficient in Microsoft Office.