Remote RN Utilization Management Nurse Consultant

CVS Health; Bastrop (LA); Remote; USD 36,000 - 85,000; Full time

Job summary

CVS Health in the United States 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, 3+ years of RN experience, and 1+ year Med/Surg experience.

You will apply clinical guidelines, collaborate with providers, and serve as a clinical resource within utilization management.

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).

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

Willingness to work schedule

Tools

Microsoft Office

Job description

CVS Health in the United States 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, 3+ years of RN experience, and 1+ year Med/Surg experience.

You will apply clinical guidelines, collaborate with providers, and serve as a clinical resource within utilization management.