Remote Utilization Management RN Consultant

CVS Health; Nebraska; Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health is hiring a Utilization Management Nurse Consultant (Clinical Precertification RN, Medicare) for a remote, full-time weekday role. You will review clinical cases, determine coverage decisions and coordinate care with providers to ensure appropriate treatment and member outcomes.

The position requires an active RN license, 3+ years of RN experience (1+ year in Med/Surg), strong clinical judgment and proficiency with Microsoft Office. A direct home-office setup is expected.

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–6:00pm 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

Clinical assessment

Decision-making

Microsoft Office

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is hiring a Utilization Management Nurse Consultant (Clinical Precertification RN, Medicare) for a remote, full-time weekday role. You will review clinical cases, determine coverage decisions and coordinate care with providers to ensure appropriate treatment and member outcomes.

The position requires an active RN license, 3+ years of RN experience (1+ year in Med/Surg), strong clinical judgment and proficiency with Microsoft Office. A direct home-office setup is expected.