Remote Utilization Management Nurse Consultant (Medicare)

CVS Health; Iowa Center (IA); Remote; USD 36,000 - 85,000; Full time

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant to ensure Medicare members receive appropriate care. This is a remote, full-time role with a weekday schedule and a base hourly pay range.

You will review cases, collaborate with providers, and apply clinical judgment to support decisions across care teams. Ideal candidates hold an RN license, have 3+ years of RN experience including Med/Surg, and can work standard daytime hours in their time zone.

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–6:00pm PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include 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

RN experience

Med/Surg

Clinical assessment

MS Office

Work schedule flexibility

Associate degree in nursing

Education

Associate Degree in Nursing

Tools

Microsoft Office (Outlook, Teams, Excel)

Job description

CVS Health is seeking an Utilization Management Nurse Consultant to ensure Medicare members receive appropriate care. This is a remote, full-time role with a weekday schedule and a base hourly pay range.

You will review cases, collaborate with providers, and apply clinical judgment to support decisions across care teams. Ideal candidates hold an RN license, have 3+ years of RN experience including Med/Surg, and can work standard daytime hours in their time zone.