Remote Utilization Management Nurse Consultant

CVS Health Corporation; North Carolina; Hybrid; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, & vision

Paid time off

Retirement plan

Job summary

CVS Health Corporation is seeking an experienced RN for a remote precertification role. You will evaluate clinical information, apply guidelines, and determine authorization for procedures while maintaining a high standard of accuracy and patient privacy.

The position supports a telework model with office-style expectations and requires strong computer skills, a professional demeanor, and the ability to work efficiently in a fast-paced environment.

Qualifications

• Active, current and unrestricted RN licensure in state of residence with at least an Associate's Degree.
• 3+ years of clinical nursing experience.
• Willing to work Monday–Friday 8 am–5 pm with occasional weekend/holiday on-call or rotating 10-hour shifts.
• Proficient computer skills across multiple systems.
• Ability to work in a fast-paced environment.

Responsibilities

• Apply precertification criteria and clinical guidelines to authorize procedures/services.
• Review clinical information from providers and initiate referrals when needed.

Skills

RN licensure

Nursing experience

Work schedule flexibility

Education

Associate degree

BSN preferred

Job description

CVS Health Corporation is seeking an experienced RN for a remote precertification role. You will evaluate clinical information, apply guidelines, and determine authorization for procedures while maintaining a high standard of accuracy and patient privacy.

The position supports a telework model with office-style expectations and requires strong computer skills, a professional demeanor, and the ability to work efficiently in a fast-paced environment.