Remote Utilization Nurse Consultant (Medicare)

CVS Health Corporation; Harrisburg (Dauphin County); Remote; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health Corporation is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN) for Medicare Complex Spine Team. This remote, full-time role supports ensuring the right care at the right time and collaborates with providers and care teams.

You will review cases, make coverage determinations using guidelines, and apply clinical judgment. Must hold an RN license in state of residence, with 3+ years’ RN experience including 1+ year in Med/Surg; Monday–Friday 9:00 AM–5:30

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)
• Ability to work Monday–Friday, 9:00 AM–5:30 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 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 clinical experience

Clinical assessment

Decision making

Microsoft Office

Education

Associate Degree in Nursing

Tools

Microsoft Office (Outlook Teams Excel)

Job description

CVS Health Corporation is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN) for Medicare Complex Spine Team. This remote, full-time role supports ensuring the right care at the right time and collaborates with providers and care teams.

You will review cases, make coverage determinations using guidelines, and apply clinical judgment. Must hold an RN license in state of residence, with 3+ years’ RN experience including 1+ year in Med/Surg; Monday–Friday 9:00 AM–5:30