Remote Spine Utilization Nurse Consultant

CVS Health Corporation; Ohio; Hybrid; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Job summary

CVS Health Corporation invites an experienced Utilization Management Nurse Consultant to join the Spine Team in a remote, full-time capacity. You will review spine-related prior authorizations, apply evidence-based criteria, and collaborate with providers and Medical Directors to support appropriate care decisions.

The role requires 3–5+ years of clinical nursing, an active RN license, and strong documentation and communication skills. Minimum ASN; BSN preferred.

Qualifications

• Active, unrestricted RN license in state of residence.
• 3–5+ years of clinical nursing experience.
• Knowledge of medical necessity review and evidence-based practice.
• Strong communication and thorough documentation skills.
• Willingness to obtain additional state licensure as needed.

Responsibilities

• Review prior authorization requests for spine procedures and services.
• Apply criteria including MCG guidelines and clinical policies.
• Assess clinical records and treatment plans.
• Collaborate with providers, Medical Directors, and plan teams.
• Ensure regulatory and organizational compliance; meet quality targets.

Skills

RN license

Clinical nursing

Critical thinking

Communication

Documentation

Education

ASN required

BSN preferred

Tools

Microsoft Office 365

EHR portal

Job description

CVS Health Corporation invites an experienced Utilization Management Nurse Consultant to join the Spine Team in a remote, full-time capacity. You will review spine-related prior authorizations, apply evidence-based criteria, and collaborate with providers and Medical Directors to support appropriate care decisions.

The role requires 3–5+ years of clinical nursing, an active RN license, and strong documentation and communication skills. Minimum ASN; BSN preferred.