Remote RN: Utilization Mgmt & Precertification

CVS Health; Tallahassee (FL); Remote; USD 40,000 - 86,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) for a remote, full-time role. The position supports treatment planning, prior authorization decisions, and quality improvement in a Medicare context.

The role requires an active RN license in the state of residence, at least 3 years of RN experience (1 in Medical-Surgical), and UM/Care Management experience. Strong Microsoft Office skills and knowledge of MedCompass are preferred.

Qualifications

• Active, unrestricted RN license in the state of residence.
• Minimum 3 years of RN experience, including at least 1 year in Medical-Surgical Nursing.
• Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel.
• Associate Degree in Nursing (ADN).
• Ability to work Monday-Friday, 9:00 AM-5:30 PM in your local time zone.
• Utilization Management, Prior Authorization, or Care Management experience.
• Managed care experience.
• Experience using MedCompass or similar UM platforms.
• Ambulatory surgery or outpatient clinical experience.
• Bachelor of Science in Nursing (BSN).

Responsibilities

• Collaborate with providers and interdisciplinary care teams to support treatment planning.
• Apply clinical judgment to utilization management and prior authorization decisions.
• Identify opportunities to improve quality, outcomes, and member experience.
• Serve as a trusted clinical resource for internal and external stakeholders.

Skills

RN clinical knowledge

Microsoft Office proficiency

Team collaboration

Remote working readiness

Education

ADN

BSN

Tools

MedCompass

Microsoft Teams

Microsoft Outlook

Microsoft Excel

Job description

CVS Health is seeking an Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) for a remote, full-time role. The position supports treatment planning, prior authorization decisions, and quality improvement in a Medicare context.

The role requires an active RN license in the state of residence, at least 3 years of RN experience (1 in Medical-Surgical), and UM/Care Management experience. Strong Microsoft Office skills and knowledge of MedCompass are preferred.