Utilization Management Nurse Consultant

CVS Health Corporation

Harrisburg (Dauphin County)

Remote

USD 40,000 - 85,000

Full time

33 hours ago

Be an early applicant

Get a reply from this employer

Your resume and cover letter, tailored to exactly what they’re hiring for.

Get past ATS filters

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health Corporation is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN) for Medicare Complex Spine Team. This remote, full-time role supports ensuring the right care at the right time and collaborates with providers and care teams.

You will review cases, make coverage determinations using guidelines, and apply clinical judgment. Must hold an RN license in state of residence, with 3+ years’ RN experience including 1+ year in Med/Surg; Monday–Friday 9:00 AM–5:30

Qualifications

Active, unrestricted RN license in the state of residence.
3+ years of 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–5:30 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
Associate Degree in Nursing

Responsibilities

Review clinical cases and make coverage determinations using evidence-based guidelines
Collaborate with providers and care teams to coordinate appropriate 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 clinical experience

Clinical assessment

Decision making

Microsoft Office

Education

Associate Degree in Nursing

Tools

Microsoft Office (Outlook Teams Excel)

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare- Complex Spine Team)

Remote | Full-Time | Weekday Schedule

Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time.

What You’ll Do

Review clinical cases and make coverage determinations using evidence-based guidelines
Collaborate with providers and care teams to coordinate appropriate 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

What You Bring - REQUIRED

Active, unrestricted RN license in the state of residence.
3+ years of 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–5:30 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
Associate Degree in Nursing

Nice to Have

Utilization Management or Prior Authorization experience
Managed care background
Familiarity with MedCompass
Ambulatory surgery experience
BSN preferred

Why Join Us?

Transition your clinical skills into a collaborative, non-bedside role
Make a meaningful impact on patient care and outcomes
Work in a supportive, team-driven environment

If you’re passionate about combining clinical expertise with care coordination and healthcare quality, we’d love to hear from you!

Work From Home Requirements

You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical And Logistical Requirements

Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$29.10 - $62.32

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great Benefits For Great People