Remote Utilization Nurse Consultant (Medicare)

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced Utilization Management Nurse Consultant (RN) for Medicare precertification. This remote, full‑time role focuses on review of clinical cases, evidence‑based coverage determinations, and collaboration with providers to coordinate care.

You will apply clinical judgment to support utilization and benefit management decisions, while working a Monday–Friday schedule in your time zone. RN license, 3+ years of experience (1+ year Med/Surg) required.

Qualifications

• Active, unrestricted RN license in 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–6:00 PM in your time zone.
• 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 licensure

Clinical assessment

Microsoft Office

Education

Associate Degree in Nursing

Active RN license

Tools

EHR systems

Job description

CVS Health is seeking an experienced Utilization Management Nurse Consultant (RN) for Medicare precertification. This remote, full‑time role focuses on review of clinical cases, evidence‑based coverage determinations, and collaboration with providers to coordinate care.

You will apply clinical judgment to support utilization and benefit management decisions, while working a Monday–Friday schedule in your time zone. RN license, 3+ years of experience (1+ year Med/Surg) required.