Remote Utilization Management Nurse Consultant - Medicare

CVS Health; East Windsor Hill (CT); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN) for Medicare on a remote, full-time basis. You will review clinical cases, determine coverage, coordinate care, and support decision-making for member outcomes.

The role requires an active RN license in your state, 3+ years of RN experience (1+ year in Med/Surg), strong clinical skills, and MS Office proficiency. Schedule is Monday–Friday, 9:00 AM–6:00 PM in your time zone; holidays/evening hours may

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; Utilization Management is a 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

Clinical assessment

Time management

Schedule coordination

Education

Associate Degree in Nursing

BSN preferred

Tools

MS Office

Job description

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN) for Medicare on a remote, full-time basis. You will review clinical cases, determine coverage, coordinate care, and support decision-making for member outcomes.

The role requires an active RN license in your state, 3+ years of RN experience (1+ year in Med/Surg), strong clinical skills, and MS Office proficiency. Schedule is Monday–Friday, 9:00 AM–6:00 PM in your time zone; holidays/evening hours may