Remote Utilization Management Nurse Consultant

CVS Health; United States; Remote; USD 54,000 - 130,000; Full time

Benefits offered by this job

Bonus eligibility

Incentive program

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to work remotely on a full-time weekend schedule. You will review clinical information to support coverage determinations, apply guidelines, and collaborate with care teams to coordinate treatment plans.

Ideal candidates hold an active RN license with 3+ years of RN experience and at least 1 year in Med/Surg, plus proficiency with Microsoft Office.

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).
• Willingness to work required schedule post-training.

Responsibilities

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines, policies, and sound judgment across the care continuum.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to enhance quality, efficiency, and member outcomes.
• Refer members to additional programs and services as appropriate.
• Serve as a clinical resource within utilization/benefit management.

Skills

RN license

RN experience

Med/Surg experience

Microsoft Office proficiency

Willingness to work schedule

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to work remotely on a full-time weekend schedule. You will review clinical information to support coverage determinations, apply guidelines, and collaborate with care teams to coordinate treatment plans.

Ideal candidates hold an active RN license with 3+ years of RN experience and at least 1 year in Med/Surg, plus proficiency with Microsoft Office.