Utilization Management Nurse Consultant

4004 Aetna Medicaid Administrators; Virginia (MN); Hybrid; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement options

Job summary

CVS Health is seeking a remote Precertification Nurse to review clinical information and authorize procedures from providers. The role is telework everywhere with a preference for Virginia residents or those with Virginia licensure.

You will collect data by phone, apply evidence-based criteria, and initiate Medical Director referrals as needed. Candidates must hold an active RN license with at least an Associate’s degree and 3+ years of nursing experience.

Qualifications

• Active, current RN license in resident state with an Associate’s Degree.
• 3+ years of clinical nursing experience.
• Ability to work 8am-5pm with occasional on-call weekends/holidays.

Responsibilities

• Conduct precertification reviews using clinical criteria.
• Review medical information from providers and authorize procedures/services.
• Initiate Medical Director referrals as needed.
• Work from home with a dedicated home office setup.

Skills

RN licensure

Clinical nursing

Flexible schedule

Computer skills

Education

Associate degree

BSN preferred

Tools

EHR systems

Microsoft Office 365

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.

Position Summary

This role is Telework anywhere! Preference for Virginia residents or out of state residents that have the Virginia licensure and/or compact licensure. Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification. Most of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. Sedentary work involves periods of sitting, talking, listening and computer use.

Required Qualifications

• Must have active, current and unrestricted RN licensure in state of residence with at least an Associate’s Degree
• 3+years of clinical experience in nursing
• Must be wiling and able to work Monday - Friday 8 am - 5 pm with occasional weekend/holiday on-call or rotating 10 hour shifts
• Proficient computer skills which include navigating multiple systems
• Ability to work in a fast-paced environment

Preferred Qualifications

• Previous prior authorization experience
• Compact RN licensure
• Education Associates degree required
• BSN preferred

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 40

Time Type Full time

Pay Range

The typical pay range for this role is: $26.01 - $68.55. 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.

Benefits

Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We anticipate the application window for this opening will close on: 10/07/2026

About Us

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.