Remote Utilization Management Nurse Consultant (Medicare)

CVS Health; Florida; Hybrid; USD 40,000 - 86,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a licensed RN for Utilization Management Nurse Consultant (Medicare) to work remotely in a full-time, Monday–Friday schedule. You will review cases, determine coverage using criteria, and collaborate with care teams to guide treatment planning.

This role emphasizes clinical judgment, quality outcomes, and cost-effective care. The position requires an active RN license, 3+ years of RN experience (1+ in Medical-Surgical), strong assessment skills, and proficiency with MS

Qualifications

• Active, unrestricted RN license in the state of residence.
• Minimum 3 years of RN experience, including at least 1 year in Medical-Surgical Nursing.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel.
• Associate Degree in Nursing (ADN).
• Ability to work Monday-Friday, 9:00 AM-5:30 PM in your local time zone.

Responsibilities

• Review clinical cases and make coverage determinations using evidence-based criteria.
• Collaborate with providers and interdisciplinary care teams to support treatment planning.
• Apply clinical judgment to utilization management and prior authorization decisions.
• Identify opportunities to improve quality, outcomes, and member experience.
• Serve as a trusted clinical resource for internal and external stakeholders.

Skills

RN license

RN experience

Clinical assessment

MS Office proficiency

Critical thinking

Decision making

Education

ADN

BSN (preferred)

Tools

Teams

Outlook

Excel

Job description

CVS Health is seeking a licensed RN for Utilization Management Nurse Consultant (Medicare) to work remotely in a full-time, Monday–Friday schedule. You will review cases, determine coverage using criteria, and collaborate with care teams to guide treatment planning.

This role emphasizes clinical judgment, quality outcomes, and cost-effective care. The position requires an active RN license, 3+ years of RN experience (1+ in Medical-Surgical), strong assessment skills, and proficiency with MS