RN Utilization & Quality Management Consultant

CVS Health; Bozeman (MT); Remote; USD 36,000 - 95,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess and coordinate care for members. Schedule is Monday–Friday, 9:00am–5:30pm in the candidate's time zone; Utilization Management operates 24/7 with holidays and evening hours.

This remote role requires an active RN license and relevant clinical experience. The role emphasizes collaboration with providers, utilization review, and referral opportunities to optimize care and benefits.

Qualifications

• ~3+ years of experience as a Registered Nurse.
• Active current and unrestricted RN license in state of residence.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply clinical criteria/guidelines to render coverage determinations.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other products/services/programs.
• Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to internal and external constituents in utilization/benefit management.

Skills

RN experience

Clinical nursing

Education

Associates degree

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess and coordinate care for members. Schedule is Monday–Friday, 9:00am–5:30pm in the candidate's time zone; Utilization Management operates 24/7 with holidays and evening hours.

This remote role requires an active RN license and relevant clinical experience. The role emphasizes collaboration with providers, utilization review, and referral opportunities to optimize care and benefits.