Remote RN: Utilization Management & Precertification (Weekend)

CVS Health; Clayton (NC); Remote; USD 36,000 - 86,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for a remote, full-time weekend schedule. The role focuses on review of clinical data to determine coverage decisions, applying guidelines, collaborating with care teams, and identifying opportunities to improve outcomes.

Ideal candidates hold an active RN license and have 3+ years RN experience with at least 1 year in Med/Surg, plus proficiency in MS 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

Attention to detail

RN license

RN experience

Med/Surg experience

Schedule flexibility

Tools

MS Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for a remote, full-time weekend schedule. The role focuses on review of clinical data to determine coverage decisions, applying guidelines, collaborating with care teams, and identifying opportunities to improve outcomes.

Ideal candidates hold an active RN license and have 3+ years RN experience with at least 1 year in Med/Surg, plus proficiency in MS Office.