Remote Utilization Management Nurse Consultant

CVS Health; Butlerville (IN); Remote; USD 36,000 - 86,000; Full time

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant to review clinical cases and make coverage decisions in a remote, full-time role. You will collaborate with providers and care teams, apply clinical judgment, and support utilization and benefit management decisions to improve member outcomes.

The role requires an RN license, 3+ years RN experience (1+ in Med/Surg), and strong Microsoft Office skills.

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.
• 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

Clinical assessment

Decision making

Microsoft Office

Time management

Education

Associate Degree in Nursing

RN license (active, unrestricted)

Tools

Microsoft Office 365

Job description

CVS Health is seeking an Utilization Management Nurse Consultant to review clinical cases and make coverage decisions in a remote, full-time role. You will collaborate with providers and care teams, apply clinical judgment, and support utilization and benefit management decisions to improve member outcomes.

The role requires an RN license, 3+ years RN experience (1+ in Med/Surg), and strong Microsoft Office skills.