Remote RN: Utilization Management & Precertification

CVS Health; Austin (TX); Remote; USD 36,000 - 85,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations and care coordination. This remote, full-time role features a weekend schedule after training and requires strong clinical judgment and proficiency with Microsoft Office.

You will review clinical information, apply guidelines, collaborate with providers, and help optimize member outcomes while navigating compliance and HIPAA requirements.

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

Active, unrestricted RN license

RN experience

Microsoft Office proficiency

Education

Associate’s degree

BSN preferred

Tools

Microsoft Office 365

Outlook

Teams

Excel

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations and care coordination. This remote, full-time role features a weekend schedule after training and requires strong clinical judgment and proficiency with Microsoft Office.

You will review clinical information, apply guidelines, collaborate with providers, and help optimize member outcomes while navigating compliance and HIPAA requirements.