Remote Utilization Management RN Advisor

CVS Health; East Honolulu (HI); Remote; USD 36,000 - 86,000; Full time

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN, Medicare) to join our team remotely in a full-time weekday schedule. This role focuses on reviewing cases, coordinating care, and applying clinical judgment to ensure members receive appropriate care at the right time.

The ideal candidate holds an active RN license, 3+ years of RN experience including 1+ year in Med/Surg, and strong assessment skills.

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–6:00 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

Clinical assessment

Microsoft Office

Time-zone friendly schedule

Associate Degree in Nursing

Education

Associate Degree in Nursing

Tools

Microsoft Office

Job description

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN, Medicare) to join our team remotely in a full-time weekday schedule. This role focuses on reviewing cases, coordinating care, and applying clinical judgment to ensure members receive appropriate care at the right time.

The ideal candidate holds an active RN license, 3+ years of RN experience including 1+ year in Med/Surg, and strong assessment skills.