Remote Utilization Management Nurse Consultant

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Comprehensive benefits package

Job summary

CVS Health Corporation is seeking a Telework RN Precertification Specialist to apply clinical criteria, review information from providers, and authorize necessary procedures. The role emphasizes accurate data gathering, HIPAA-compliant handling, and coordinating with medical directors as needed.

The position requires active RN licensure, 3+ years of nursing experience, and the ability to work standard hours with on-call on weekends or holidays.

Qualifications

• Active, current and unrestricted RN licensure in the state of residence with an Associate's Degree.
• 3+ years of clinical nursing experience.
• Willingness to work Monday–Friday 8am–5pm with occasional weekend/holiday on-call or rotating 10-hour shifts.

Responsibilities

• Collect and review clinical information from providers.
• Apply precertification criteria to authorize procedures/services.
• Initiate Medical Director referrals when needed.

Skills

RN licensure

Clinical experience

Work schedule

Computer skills

Fast-paced environment

Education

Associate's degree

BSN preferred

Tools

Microsoft Office 365

Google Workspace

Job description

CVS Health Corporation is seeking a Telework RN Precertification Specialist to apply clinical criteria, review information from providers, and authorize necessary procedures. The role emphasizes accurate data gathering, HIPAA-compliant handling, and coordinating with medical directors as needed.

The position requires active RN licensure, 3+ years of nursing experience, and the ability to work standard hours with on-call on weekends or holidays.