Remote Utilization Management Nurse Consultant (Medicare)

CVS Health; Indiana; 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 for Medicare to work remotely in a full-time weekday schedule. You will review clinical cases, determine coverage using guidelines, and collaborate with care teams to ensure appropriate treatment and efficient utilization management.

The role requires an RN license, 3+ years of experience (1+ year in Med/Surg), strong clinical judgment, and proficiency with Microsoft Office.

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; schedule may include holidays and evenings.

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

3+ years RN

1+ year Med/Surg

Clinical assessment

MS Office

Weekday schedule availability

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office (Outlook, Teams, Excel)

Job description

CVS Health is seeking a Utilization Management Nurse Consultant for Medicare to work remotely in a full-time weekday schedule. You will review clinical cases, determine coverage using guidelines, and collaborate with care teams to ensure appropriate treatment and efficient utilization management.

The role requires an RN license, 3+ years of experience (1+ year in Med/Surg), strong clinical judgment, and proficiency with Microsoft Office.