Remote Utilization Nurse Consultant — Precertification

Hispanic Alliance for Career Enhancement; Colorado; Hybrid; USD 35,817 - 95,054; Full time

Benefits offered by this job

Comprehensive benefits

Remote work

Bonus eligibility

Job summary

CVS Health is seeking an experienced Utilization Management Nurse for precertification in a remote, full-time role with a 40-hour work week. You will review clinical information, apply guidelines, and authorize services while coordinating with providers and Medical Directors to ensure timely coverage decisions.

The role emphasizes critical thinking, heavy system navigation, and a non-bedside setting, enabling rapid decision-making in a production-driven environment.

Qualifications

• Active, current RN license in Virginia or a Multi-State Compact state.
• 3+ years of clinical nursing experience.
• Strong critical thinking and clinical decision-making skills.
• Proficiency navigating multiple computer systems simultaneously.
• Ability to thrive in a fast-paced, production-driven environment.
• Associate Degree in Nursing required.

Responsibilities

• Review clinical information and apply evidence-based criteria and guidelines to precertification requests.
• Collect and assess medical information from providers via phone and electronic systems.
• Authorize services and procedures within established guidelines.
• Refer complex cases to Medical Directors when additional review is required.
• Collaborate with providers and internal teams to support timely coverage decisions.
• Navigate multiple systems while managing a high-volume workload in a fast-paced environment.

Skills

RN license

Clinical nursing experience

Critical thinking

Multi-system navigation

Fast-paced environment

Education

Associate Degree in Nursing

BSN preferred

Tools

EMR systems

Job description

CVS Health is seeking an experienced Utilization Management Nurse for precertification in a remote, full-time role with a 40-hour work week. You will review clinical information, apply guidelines, and authorize services while coordinating with providers and Medical Directors to ensure timely coverage decisions.

The role emphasizes critical thinking, heavy system navigation, and a non-bedside setting, enabling rapid decision-making in a production-driven environment.