Remote Utilization Management RN – Medicare Precertification

CVS Health; Austin (TX); Remote; USD 40,000 - 86,000; Full time

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant to apply clinical expertise beyond the bedside. In Medicare precertification, you will review cases, determine coverage and coordinate care with providers while working remotely in a full-time weekday schedule.

The role requires an active RN license, 3+ years of RN experience including Med/Surg, and strong assessment and decision-making skills. You will use MS Office tools and support a 9:00 to 17:30 schedule in a fixed time zone.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years 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–5:30 PM in your time zone; Utilization Management is a 24/7 operation and schedules include holidays/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

Clinical assessment

Decision making

Microsoft Office

Time zone scheduling

Education

Associate Degree in Nursing

Tools

Microsoft Office (Outlook/Teams/Excel)

Job description

CVS Health is seeking a Utilization Management Nurse Consultant to apply clinical expertise beyond the bedside. In Medicare precertification, you will review cases, determine coverage and coordinate care with providers while working remotely in a full-time weekday schedule.

The role requires an active RN license, 3+ years of RN experience including Med/Surg, and strong assessment and decision-making skills. You will use MS Office tools and support a 9:00 to 17:30 schedule in a fixed time zone.