Remote Utilization Nurse Consultant - Precertification Expert

CVS Health Corporation; Wisconsin; Hybrid; USD 74,749,000 - 196,424,000; Full time

Job summary

CVS Health is seeking a Remote Precertification Nurse to collect and review clinical information from providers and authorize procedures or referrals. This role requires an active RN license and 3+ years of nursing experience, with a Monday–Friday schedule and possible on-call duties.

The position emphasizes HIPAA-compliant home office setup, strong computer skills, and the ability to work in a fast-paced environment while maintaining accuracy and efficiency.

Qualifications

• Active, current RN licensure in resident state (unrestricted).
• 3+ years of clinical nursing experience.
• Able to work Monday–Friday 8am–5pm with occasional weekends/holidays or rotating 10-hour shifts.
• Proficient with multiple systems on a computer.
• Capable of performing in a fast-paced environment.

Responsibilities

• Review clinical information from providers for precertification.
• Apply clinical criteria and guidelines to authorize procedures/services.
• Coordinate with Medical Director as needed.

Skills

RN licensure

Nursing experience

Work schedule

Computer skills

Fast-paced environment

Education

Associate degree

BSN (preferred)

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Remote Precertification Nurse to collect and review clinical information from providers and authorize procedures or referrals. This role requires an active RN license and 3+ years of nursing experience, with a Monday–Friday schedule and possible on-call duties.

The position emphasizes HIPAA-compliant home office setup, strong computer skills, and the ability to work in a fast-paced environment while maintaining accuracy and efficiency.