Remote Utilization Management Nurse Consultant

CVS Health Corporation; Louisiana (MO); Hybrid; USD 36,000 - 95,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus opportunities

Job summary

CVS Health Corporation is seeking a Telework RN for precertification review and coordination. The role focuses on collecting and evaluating clinical information from providers, applying evidence-based guidelines, and initiating Medical Director referrals as needed.

Ideal candidates have an active RN license, 3+ years of clinical nursing experience, and ability to manage multiple systems in a fast-paced environment while supporting a remote work setup with HIPAA compliance.

Qualifications

• Active, current RN license in home state with at least an Associate's Degree.
• 3+ years of clinical nursing experience.
• Willingness to work Monday–Friday 8 am–5 pm with occasional weekend/holiday on-call or rotating 10-hour shifts.
• Proficient with multiple systems and strong computer skills.

Responsibilities

• Apply clinical criteria and guidelines to precertification decisions.
• Review clinical information from providers and authorize procedures/services as needed.
• Coordinate with medical directors when referrals are required.

Skills

Critical thinking

Strong communication

Proficient computer skills

Phone-based coordination

Education

Associate's degree

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health Corporation is seeking a Telework RN for precertification review and coordination. The role focuses on collecting and evaluating clinical information from providers, applying evidence-based guidelines, and initiating Medical Director referrals as needed.

Ideal candidates have an active RN license, 3+ years of clinical nursing experience, and ability to manage multiple systems in a fast-paced environment while supporting a remote work setup with HIPAA compliance.