Remote UM Nurse Consultant - Medicare Precertification (RN)

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

Benefits offered by this job

Comprehensive benefits package

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant – Clinical Precertification RN (Medicare) for a remote, full-time role. The position supports utilization management and prior authorization decisions, collaborating with providers and care teams to ensure appropriate care and outcomes.

The ideal candidate holds an RN license, 3+ years of nursing experience (including 1 year in Medical‑Surgical), and proficiency in MS Office.

Qualifications

• Active, unrestricted RN license in 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.
• ADN degree.
• Ability to work Monday-Friday, 9:00 AM-5:30 PM in 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.
• BSN degree.

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

Active RN license

Education

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Tools

Microsoft Office (Outlook, Teams, Excel)

MedCompass or UM platforms

Job description

CVS Health is seeking a Utilization Management Nurse Consultant – Clinical Precertification RN (Medicare) for a remote, full-time role. The position supports utilization management and prior authorization decisions, collaborating with providers and care teams to ensure appropriate care and outcomes.

The ideal candidate holds an RN license, 3+ years of nursing experience (including 1 year in Medical‑Surgical), and proficiency in MS Office.