Remote Utilization Management RN – Precertification

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

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant (Medicare) to apply evidence-based guidelines, review clinical cases, and determine appropriate coverage for members. This remote, full-time role supports a 9:00 AM–6:00 PM time frame in the user’s time zone and involves collaboration with providers and care teams to coordinate necessary treatments.

The position emphasizes strong clinical assessment and decision-making, with a focus on improving member outcomes and ensuring

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)
• 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

Education

Associate Degree in Nursing

Tools

Microsoft Office

Job description

CVS Health is seeking a Utilization Management Nurse Consultant (Medicare) to apply evidence-based guidelines, review clinical cases, and determine appropriate coverage for members. This remote, full-time role supports a 9:00 AM–6:00 PM time frame in the user’s time zone and involves collaboration with providers and care teams to coordinate necessary treatments.

The position emphasizes strong clinical assessment and decision-making, with a focus on improving member outcomes and ensuring