Remote Utilization Management RN Consultant – Medicare

CVS Health

Florida

Remote

USD 40,000 - 86,000

Full time

6 days ago

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Job summary

CVS Health is seeking an Utilization Management Nurse Consultant – Clinical Precertification RN for Medicare. This fully remote, full-time role supports the UM team to ensure appropriate care decisions across plans and providers.

You will review cases, collaborate with care teams, and contribute to quality outcomes while working standard business hours in your time zone. The position requires an active RN license, 3+ years of RN experience including medical-surgical exposure, and UM/CM

Qualifications

Active, unrestricted RN license in the state of residence.
Minimum 3 years of RN experience, including at least 1 year in Medical-Surgical Nursing.
Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel.
Associate Degree in Nursing (ADN) required.
Ability to work Monday-Friday, 9:00 AM-5:30 PM in local time zone.
Utilization Management, Prior Authorization, or Care Management experience.
Managed care experience.
Experience using MedCompass or similar UM platforms.
Ambulatory surgery or outpatient clinical experience.

Responsibilities

Collaborate with providers and interdisciplinary care teams to support treatment planning.
Apply clinical judgment to utilization management and prior authorization decisions.
Identify opportunities to improve quality, outcomes, and member experience.
Serve as a trusted clinical resource for internal and external stakeholders.