Remote Utilization Management RN Weekend

CVS Health; Fulton (MS); Remote; USD 36,000 - 86,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for remote, full-time weekend work. You will review clinical information to support coverage determinations, apply guidelines, and coordinate treatment plans with care teams to improve member outcomes.

Required RN license and 3+ years of RN experience; 1+ year Med/Surg experience; strong MS Office skills; willingness to work post-training schedule.

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).
• Willingness to work required schedule post-training.

Responsibilities

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines, policies, and sound judgment across the care continuum.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to enhance quality, efficiency, and member outcomes.
• Refer members to additional programs and services as appropriate.
• Serve as a clinical resource within utilization/benefit management.

Skills

RN license

RN experience

Med/Surg experience

Microsoft Office

Schedule flexibility

Education

Associate’s degree required

BSN preferred

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for remote, full-time weekend work. You will review clinical information to support coverage determinations, apply guidelines, and coordinate treatment plans with care teams to improve member outcomes.

Required RN license and 3+ years of RN experience; 1+ year Med/Surg experience; strong MS Office skills; willingness to work post-training schedule.