Remote Utilization Management RN Consultant

CVS Health; Concord (NH); Remote; USD 40,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) to work remotely. You will review cases, support providers and interdisciplinary teams, and apply clinical judgment for pre-certifications.

The role requires an active RN license, ADN (BSN preferred), and 3+ years of RN experience. 9:00–5:30 local time, Mon-Fri; occasional after-hours may apply. Strong UM platforms experience is a plus.

Qualifications

• Active RN license in state of residence.
• Minimum 3 years RN experience.
• Strong clinical assessment, critical thinking and decision-making.
• Proficiency with Microsoft Office (Outlook/Teams/Excel).
• ADN required; BSN preferred.

Responsibilities

• Review clinical cases and determine coverage using criteria.
• Collaborate with providers and care teams on treatment planning.
• Apply clinical judgment to UM and prior authorizations.
• Identify opportunities to improve quality, outcomes and member experience.
• Serve as clinical resource for stakeholders.

Skills

Active RN license (unrestricted)

RN experience (3+ years)

Clinical assessment

Critical thinking

Decision-making

MS Office (Outlook, Teams, Excel)

Education

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Tools

MedCompass

Job description

CVS Health is seeking an Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) to work remotely. You will review cases, support providers and interdisciplinary teams, and apply clinical judgment for pre-certifications.

The role requires an active RN license, ADN (BSN preferred), and 3+ years of RN experience. 9:00–5:30 local time, Mon-Fri; occasional after-hours may apply. Strong UM platforms experience is a plus.