Remote Utilization Management Nurse Consultant (RN)

4062 Aetna Resources, LLC; Texas; Hybrid; USD 36,000 - 85,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join our remote Utilization Management team. This full-time role focuses on ensuring appropriate care coverage and optimizing member outcomes within a 4‑day weekend schedule after training.

You’ll review clinical data, apply guidelines, coordinate with providers, and serve as a clinical resource across care teams while adhering to HIPAA and safety standards.

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).
• Willingness to work required schedule post-training.

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

Attention to detail

Collaboration

Education

Associate's degree (RN) required

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join our remote Utilization Management team. This full-time role focuses on ensuring appropriate care coverage and optimizing member outcomes within a 4‑day weekend schedule after training.

You’ll review clinical data, apply guidelines, coordinate with providers, and serve as a clinical resource across care teams while adhering to HIPAA and safety standards.