Remote Utilization Management Nurse Consultant

CVS Health; North Dakota; Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical/dental/vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) for a remote, full-time role. You will review cases, coordinate care, and apply clinical judgment to support decisions, serving as a resource across stakeholders.

Requires an active RN license, 3+ years RN experience (1+ in Med/Surg), and proficiency with Outlook/Teams/Excel. Weekday schedule; travel not required. Benefits are included with full-time employment.

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–6:00pm PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include 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

Clinical assessment

Decision making

Microsoft Office

Weekday schedule

Education

Associate Degree in Nursing

Tools

Outlook

Teams

Excel

Job description

CVS Health is seeking a Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) for a remote, full-time role. You will review cases, coordinate care, and apply clinical judgment to support decisions, serving as a resource across stakeholders.

Requires an active RN license, 3+ years RN experience (1+ in Med/Surg), and proficiency with Outlook/Teams/Excel. Weekday schedule; travel not required. Benefits are included with full-time employment.