Remote RN Utilization Management Specialist

CVS Health; Central City (NE); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

PTO

Retirement plan

Wellness programs

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant to review clinical cases and ensure appropriate care within Medicare. This remote, full-time role requires RN licensure, 3+ years of experience including Med/Surg, and collaboration with care teams to optimize outcomes.

You’ll apply clinical judgment, support benefit decisions, and serve as a resource across stakeholders, with a Monday–Friday schedule and potential holiday/evening hours in your time zone.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years of RN experience, including 1+ year in Med/Surg.
• Strong clinical assessment and decision-making skills.
• Experience with Microsoft Office (Outlook, Teams, Excel).
• Ability to work Monday–Friday, 9:00 AM–6:00 PM in your time zone; holidays/evening hours may apply.
• Associate Degree in Nursing.

Responsibilities

• Review clinical cases and make coverage determinations using evidence-based guidelines.
• Collaborate with providers and care teams to coordinate appropriate treatment.
• Apply clinical judgment to support utilization and benefit management decisions.
• Identify opportunities to improve care quality and member outcomes.
• Serve as a clinical resource across internal and external stakeholders.

Skills

RN license

Clinical assessment

Decision making

Communication

Education

Associate Degree in Nursing

Tools

Microsoft Office

Job description

CVS Health is seeking an Utilization Management Nurse Consultant to review clinical cases and ensure appropriate care within Medicare. This remote, full-time role requires RN licensure, 3+ years of experience including Med/Surg, and collaboration with care teams to optimize outcomes.

You’ll apply clinical judgment, support benefit decisions, and serve as a resource across stakeholders, with a Monday–Friday schedule and potential holiday/evening hours in your time zone.