Remote Utilization Management RN Consultant

CVS Health; Clayton (MO); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for a remote, full-time role with a weekend schedule. The RN will review clinical data to support coverage determinations, apply guidelines, and coordinate care with providers to improve member outcomes.

The role requires an active RN license, 3+ years of RN experience including Med/Surg, and proficiency with Microsoft Office. Training is provided before transitioning to a 4-day weekend schedule.

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

3+ years RN experience

Med/Surg experience

Microsoft Office

Schedule flexibility

Education

Associate’s degree in Nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for a remote, full-time role with a weekend schedule. The RN will review clinical data to support coverage determinations, apply guidelines, and coordinate care with providers to improve member outcomes.

The role requires an active RN license, 3+ years of RN experience including Med/Surg, and proficiency with Microsoft Office. Training is provided before transitioning to a 4-day weekend schedule.