Remote Utilization Nurse Consultant (Medicare Precert)

CVS Health; Milton (MA); Remote; USD 36,000 - 86,000; Full time

Job summary

CVS Health is looking for a Utilization Management Nurse Consultant (Clinical Precertification RN) to evaluate cases and ensure appropriate care for Medicare members. This remote, full-time role follows a weekday schedule with a base hourly pay range.

You will review cases, collaborate with care teams, and apply clinical judgment to support coverage decisions while serving as a clinical resource across stakeholders.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years 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; holidays/evening hours may apply.
• Associate Degree in Nursing required.

Responsibilities

• Review clinical cases and make coverage determinations using guidelines.
• Collaborate with providers and care teams to coordinate 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

RN experience

Med/Surg

Clinical assessment

MS Office

Time-zone schedule

Education

Associate Degree in Nursing

Job description

CVS Health is looking for a Utilization Management Nurse Consultant (Clinical Precertification RN) to evaluate cases and ensure appropriate care for Medicare members. This remote, full-time role follows a weekday schedule with a base hourly pay range.

You will review cases, collaborate with care teams, and apply clinical judgment to support coverage decisions while serving as a clinical resource across stakeholders.