Remote Utilization Management RN Consultant

CVS Health; Central City (CO); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical

Dental

Vision

PTO

Retirement plan

Wellness programs

Other resources

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations from a remote location. The role requires strong clinical judgment, collaboration with care teams, and a weekend-oriented schedule after training.

The position emphasizes improving patient outcomes through utilization management and adherence to policies while offering a stable full-time, remote work arrangement with potential for growth and benefits.

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

RN experience

Med/Surg experience

Microsoft Office

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations from a remote location. The role requires strong clinical judgment, collaboration with care teams, and a weekend-oriented schedule after training.

The position emphasizes improving patient outcomes through utilization management and adherence to policies while offering a stable full-time, remote work arrangement with potential for growth and benefits.