Remote Utilization Management RN (Medicare)

CVS Health; Maryland City (MD); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Retirement plan

Paid time off

Job summary

CVS Health is hiring a Utilization Management Nurse Consultant (Medicare) in a remote, full-time weekday role. You will review cases, determine coverage, and coordinate care with providers while applying clinical judgment to support decisions.

Strong RN experience and an unrestricted license are required, with 3+ years of practice and 1+ year in Med/Surg. This position offers comprehensive benefits and adherence to HIPAA guidelines.

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; 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

RN license

RN experience

Clinical assessment

Microsoft Office

Time management

Education

Associate Degree in Nursing

Tools

Microsoft Office 365

Job description

CVS Health is hiring a Utilization Management Nurse Consultant (Medicare) in a remote, full-time weekday role. You will review cases, determine coverage, and coordinate care with providers while applying clinical judgment to support decisions.

Strong RN experience and an unrestricted license are required, with 3+ years of practice and 1+ year in Med/Surg. This position offers comprehensive benefits and adherence to HIPAA guidelines.