Remote Utilization Management RN — Medicare Home Health

CVS Health Corporation; Florida; Hybrid; USD 61,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligible

Job summary

CVS Health Corporation is seeking an Utilization Management Nurse Consultant for Medicare Home Care in a remote, full‑time role serving Florida members. The RN will review cases, determine coverage, and work with care teams to ensure timely, appropriate home care after hospital or post‑acute events.

The role requires an active RN license in the resident state, 2+ years of RN experience (1+ year in Med/Surg) and proficiency with MS Office.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 2+ 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. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
• Associate Degree in Nursing

Responsibilities

• Review clinical cases and make coverage determinations using evidence-based guidelines
• Collaborate with home care providers, attending MDs and care teams to coordinate a smooth transition of care
• 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

Clinical assessment

Decision making

Time management

Communication

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Outlook

Microsoft Teams

Microsoft Excel

Job description

CVS Health Corporation is seeking an Utilization Management Nurse Consultant for Medicare Home Care in a remote, full‑time role serving Florida members. The RN will review cases, determine coverage, and work with care teams to ensure timely, appropriate home care after hospital or post‑acute events.

The role requires an active RN license in the resident state, 2+ years of RN experience (1+ year in Med/Surg) and proficiency with MS Office.