Remote Utilization Management Nurse Consultant

CVS Health Corporation; Harrisburg (Dauphin County); Remote; USD 83,383,000 - 178,573,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN) to review clinical cases, collaborate with care teams, and apply clinical judgment to support coverage determinations. This remote, full-time role requires an active RN license, 3+ years of RN experience including 1+ year in Med/Surg, and strong assessment skills.

The position offers weekday hours 9:00 AM–5:30 PM in the candidate's time zone, with holidays and evening hours as needed.

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.

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

RN Experience

Med/Surg experience

Clinical assessment

Decision-making

Microsoft Office

Education

Associate Degree in Nursing

Tools

Microsoft Office

Job description

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN) to review clinical cases, collaborate with care teams, and apply clinical judgment to support coverage determinations. This remote, full-time role requires an active RN license, 3+ years of RN experience including 1+ year in Med/Surg, and strong assessment skills.

The position offers weekday hours 9:00 AM–5:30 PM in the candidate's time zone, with holidays and evening hours as needed.