Remote Utilization Management Nurse Consultant

CVS Health; Massachusetts; Remote; USD 36,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Bonus eligibility

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant for Medicare precertification, remotely accepting applications nationwide. The role emphasizes clinical judgment and collaboration to ensure appropriate care timing and treatment, aligning with Medicare guidelines and CVS Health standards.

The position requires an RN license, 3+ years of nursing experience (1+ year Med/Surg), and proficiency with Microsoft Office.

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; 24/7 operation with holidays and evening hours.
• 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

RN license

RN experience

Clinical assessment

Microsoft Office proficiency

Time management

Education

Associate Degree in Nursing

Tools

Microsoft Office

Job description

CVS Health is seeking an Utilization Management Nurse Consultant for Medicare precertification, remotely accepting applications nationwide. The role emphasizes clinical judgment and collaboration to ensure appropriate care timing and treatment, aligning with Medicare guidelines and CVS Health standards.

The position requires an RN license, 3+ years of nursing experience (1+ year Med/Surg), and proficiency with Microsoft Office.