Remote Utilization Management RN Consultant

CVS Health; New Hampshire; Remote; USD 36,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement options

Wellness programs

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN, Medicare) to work remotely in a full-time, weekday schedule. You will review cases, determine coverage using guidelines, coordinate care with providers and care teams, and apply clinical judgment to support utilization decisions.

The role requires an active RN license, 3+ years of experience (including 1+ year in Med/Surg), and proficiency with Microsoft Office.

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.

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

3+ years RN experience

Microsoft Office

Clinical decision making

Education

Associate Degree in Nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN, Medicare) to work remotely in a full-time, weekday schedule. You will review cases, determine coverage using guidelines, coordinate care with providers and care teams, and apply clinical judgment to support utilization decisions.

The role requires an active RN license, 3+ years of experience (including 1+ year in Med/Surg), and proficiency with Microsoft Office.