Remote Utilization Management Nurse - Spine Specialist

CVS Health Corporation; Austin (TX); Remote; USD 83,383,000 - 178,573,000; Full time

Job summary

CVS Health Corporation is seeking an experienced Utilization Management Nurse Consultant for the Spine Team, working remotely. You will review spine-related prior authorizations, apply MCG guidelines, assess records, and collaborate with providers and Medical Directors to support appropriate coverage decisions.

The role requires an active RN license, 3–5+ years of clinical nursing, and strong analytical and communication skills, with a remote-friendly setup and strict HIPAA compliance.

Qualifications

• Active, unrestricted RN license in state of residence.
• Willingness to obtain additional state licensure as needed.
• 3–5+ years of clinical nursing experience.
• Strong knowledge of medical necessity review and evidence-based practice.
• Excellent critical thinking, communication, and documentation skills.

Responsibilities

• Review spine-related prior authorization requests.
• Apply evidence-based criteria, including MCG guidelines and clinical policies.
• Assess clinical records, treatment plans, and provider documentation.
• Partner with providers, Medical Directors, and health plan teams to support appropriate care decisions.
• Ensure compliance with regulatory and organizational requirements.
• Meet quality, productivity, and turnaround time standards while contributing to process improvements.

Skills

RN license

Clinical nursing experience

Evidence-based practice

Critical thinking

Communication skills

Documentation skills

Education

ASN required

BSN preferred

Tools

MCG guidelines

MedCompass

QNXT

Job description

CVS Health Corporation is seeking an experienced Utilization Management Nurse Consultant for the Spine Team, working remotely. You will review spine-related prior authorizations, apply MCG guidelines, assess records, and collaborate with providers and Medical Directors to support appropriate coverage decisions.

The role requires an active RN license, 3–5+ years of clinical nursing, and strong analytical and communication skills, with a remote-friendly setup and strict HIPAA compliance.