Remote Utilization Management RN Consultant (Medicare)

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

PTO and retirement options

Wellness programs

Job summary

CVS Health is seeking an experienced RN for remote Utilization Management, focusing on ensuring members receive appropriate care. This role supports coverage determinations and collaborates with care teams while operating within a 4-day weekend schedule after training.

Training schedule is Monday–Friday, 8:30 AM–5:00 PM (EST). A strong foundation in Med/Surg and proficiency with Microsoft Office are expected, with flexibility for evenings and holidays as needed.

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficient 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

RN experience

Med/Surg experience

Microsoft Office

Availability for weekend schedule

Education

Associate’s degree

BSN preferred

Tools

Microsoft Office Suite

Job description

CVS Health is seeking an experienced RN for remote Utilization Management, focusing on ensuring members receive appropriate care. This role supports coverage determinations and collaborates with care teams while operating within a 4-day weekend schedule after training.

Training schedule is Monday–Friday, 8:30 AM–5:00 PM (EST). A strong foundation in Med/Surg and proficiency with Microsoft Office are expected, with flexibility for evenings and holidays as needed.