RN Utilization Management Consultant (Remote)

CVS Health; Philadelphia (Philadelphia County); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement savings options

Bonus potential

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to support a 24/7 utilization management operation. The role follows a Monday–Friday schedule, with holiday and evening hours as needed, and requires an active RN license.

You will assess and coordinate care, communicate with providers, and identify referral opportunities to improve member outcomes and optimize benefits. Strong MS Office and MedCompass experience are preferred.

Qualifications

• 3+ years as a Registered Nurse
• Active, unrestricted RN licensure in resident state
• 1+ years Med/Surg experience

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services/benefits for members.
• Gathers clinical information and applies criteria/policies to render coverage determinations/recommendations.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other products/services/programs.
• Promote quality and effectiveness of healthcare services and benefit utilization.

Skills

Clinical assessment

Communication skills

Time management

Education

Associate degree required

BSN preferred

RN licensure in state of residence

Tools

Microsoft Office (Outlook/Teams/Excel)

MedCompass

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to support a 24/7 utilization management operation. The role follows a Monday–Friday schedule, with holiday and evening hours as needed, and requires an active RN license.

You will assess and coordinate care, communicate with providers, and identify referral opportunities to improve member outcomes and optimize benefits. Strong MS Office and MedCompass experience are preferred.