Remote Utilization Management RN — Precetification

CVS Health; Fort Lauderdale (FL); Remote; USD 40,000 - 86,000; Full time

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) for a remote, full-time role. You will review cases, determine coverage, and collaborate with care teams to ensure appropriate care timing and setting.

The position requires an active RN license, 3 years of RN experience (1 in Med-Surg), and proficiency with MS Office. ABSN preferred; work hours are Monday–Friday, with possible after-hours as needed.

Qualifications

• Active, unrestricted RN license in your state of residence.
• Minimum 3 years of RN experience, including at least 1 year in Medical-Surgical Nursing.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel.
• ADN required; BSN preferred.

Responsibilities

• Review clinical cases and make coverage determinations using evidence-based criteria.
• Collaborate with providers and interdisciplinary care teams to support treatment planning.
• Apply clinical judgment to utilization management and prior authorization decisions.
• Identify opportunities to improve quality, outcomes, and member experience.
• Serve as a trusted clinical resource for internal and external stakeholders.

Skills

RN license active

RN experience 3+ years

clinical assessment

Microsoft Office (Outlook, Teams,Excel

Education

ADN

BSN (preferred)

Tools

Microsoft Office

Job description

CVS Health is seeking an Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) for a remote, full-time role. You will review cases, determine coverage, and collaborate with care teams to ensure appropriate care timing and setting.

The position requires an active RN license, 3 years of RN experience (1 in Med-Surg), and proficiency with MS Office. ABSN preferred; work hours are Monday–Friday, with possible after-hours as needed.