Remote RN Utilization Management Consultant

CVS Health Corporation; Virginia (MN); Hybrid; USD 54,000 - 142,000; Full time

Benefits offered by this job

Medical insurance

Dental & Vision

Paid time off

Job summary

CVS Health Corporation seeks a remote Precertification Nurse to review clinical information, apply criteria, and authorize procedures for services. The role involves working from home with a focus on HIPAA-compliant data handling and timely decision making.

Preference for Virginia licensure or out-of-state residents with Virginia licensure/compact; standard hours are Mon-Fri 8:00–17:00 with possible on-call or weekend shifts. Equipment is provided to support a secure home office setup.

Qualifications

• Must have active, current and unrestricted RN licensure in state of residence with at least an Associate's Degree.
• 3+ years of clinical nursing experience.
• Must be willing and able to work Monday - Friday 8 am - 5 pm with occasional weekend/holiday on-call or rotating 10 hour shifts.
• Proficient computer skills including navigating multiple systems.
• Ability to work in a fast-paced environment.

Responsibilities

• Apply precertification criteria and clinical practice guidelines to authorize procedures/services.
• Review clinical information from providers for precertification.
• Initiate Medical Director referrals when needed.

Skills

Critical thinking

Communication skills

Fast-paced environment

Education

Associates degree required

BSN preferred

Tools

Microsoft Office 365

EHR systems

Job description

CVS Health Corporation seeks a remote Precertification Nurse to review clinical information, apply criteria, and authorize procedures for services. The role involves working from home with a focus on HIPAA-compliant data handling and timely decision making.

Preference for Virginia licensure or out-of-state residents with Virginia licensure/compact; standard hours are Mon-Fri 8:00–17:00 with possible on-call or weekend shifts. Equipment is provided to support a secure home office setup.