Remote Utilization Management Nurse Consultant (RN)

CVS Health; Alton (IL); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Remote work

Job summary

CVS Health is seeking an experienced Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations remotely. The role requires collaborating with providers and care teams to coordinate treatment plans and ensure appropriate member outcomes.

The RN will review clinical information, apply guidelines, and act as a clinical resource within utilization/benefit management.

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).

Responsibilities

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines, policies, and sound judgment across the care continuum.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to enhance quality, efficiency, and member outcomes.
• Refer members to additional programs and services as appropriate.
• Serve as a clinical resource within utilization/benefit management.

Skills

RN license

RN experience

Med/Surg experience

MS Office

Schedule flexibility

Education

Associate's degree

BSN preferred

Tools

Microsoft Office 365

MedCompass

Job description

CVS Health is seeking an experienced Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations remotely. The role requires collaborating with providers and care teams to coordinate treatment plans and ensure appropriate member outcomes.

The RN will review clinical information, apply guidelines, and act as a clinical resource within utilization/benefit management.