Remote Utilization Management Nurse Consultant (Medicare)

CVS Health; Wilmington (VT); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant (RN) for Medicare precertification, offering a remote, full-time weekday schedule. You’ll review cases, coordinate treatments, and apply clinical judgment to support decisions impacting member care.

Ideal candidates hold an RN license in their state, 3+ years RN experience (1+ in Med/Surg), and a nursing Associate degree. Proficiency in Microsoft Office is expected, with work hours Monday–Friday and occasional holidays.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years RN experience, including 1+ year Med/Surg.
• Strong clinical assessment and decision-making skills.
• Experience with Microsoft Office (Outlook, Teams, Excel).
• 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 licensure

Clinical assessment

Time management

Communication skills

Education

Associate Degree in Nursing

Tools

Microsoft Office

Job description

CVS Health is seeking an Utilization Management Nurse Consultant (RN) for Medicare precertification, offering a remote, full-time weekday schedule. You’ll review cases, coordinate treatments, and apply clinical judgment to support decisions impacting member care.

Ideal candidates hold an RN license in their state, 3+ years RN experience (1+ in Med/Surg), and a nursing Associate degree. Proficiency in Microsoft Office is expected, with work hours Monday–Friday and occasional holidays.