Remote Utilization Management RN Consultant (Weekend)

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

Benefits offered by this job

Medical

Dental

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations and care coordination from a remote location. You will apply clinical guidelines, collaborate with providers, and help ensure members receive appropriate care.

The role requires an active RN license, 3+ years of RN experience, and 1+ year Med/Surg experience, with a weekend 4‑day schedule after training.

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office 365 applications.

Responsibilities

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines and policies 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

Detail-oriented

Clinical judgment

Communication

Education

RN license (Active, unrestricted)

3+ years RN experience

1+ year Med/Surg experience

BSN preferred (Associate’s required)

Tools

Microsoft Office (Outlook)

Microsoft Teams

Excel

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations and care coordination from a remote location. You will apply clinical guidelines, collaborate with providers, and help ensure members receive appropriate care.

The role requires an active RN license, 3+ years of RN experience, and 1+ year Med/Surg experience, with a weekend 4‑day schedule after training.