Utilization Management Nurse Consultant – Preference for Virginia Residents

4004 Aetna Medicaid Administrators; Virginia (MN); Hybrid; USD 83,383,000 - 178,573,000; Full time

Benefits offered by this job

100% remote work

Virginia residency preference

Clinical impact in non-bedside role

Collaborative healthcare environment

Job summary

CVS Health is seeking a remote Utilization Management Nurse Consultant (RN Precertification) to join our team. The role focuses on reviewing and authorizing services using guidelines, coordinating with providers, and managing a high-volume caseload in a fully remote setting.

Preference is given to Virginia residents and candidates with Virginia and Compact RN licenses. A full-time schedule supports a stable, on-call friendly work pattern within a mission-driven healthcare environment.

Qualifications

• Active, unrestricted COMPACT RN license in state of residence.
• 3+ years of clinical nursing experience.
• Strong computer skills across multiple systems (EHRs, portals).
• Ability to work Monday–Friday, 8:00 AM–5:00 PM, with occasional weekend/holiday on-call.
• Associate's degree in Nursing required.

Responsibilities

• Review clinical information and authorization requests using evidence-based guidelines.
• Collaborate with healthcare providers to gather documentation.
• Approve services within scope or refer complex cases to Medical Director.
• Manage a high volume of cases in a phone- and computer-based environment.

Skills

Compact RN license

Clinical nursing

Computer skills

On-call availability

Education

Associate degree in Nursing

BSN (preferred)

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.

Remote UM Nurse Consultant RN Precertification Nurse (Telework) Work from anywhere!

We are seeking an experienced Registered Nurse to join our Utilization Management team in a fully remote Precertification Nurse role. Preference is given to Virginia residents or candidates holding both Virginia and Compact RN licenses.

What You’ll Do

Review clinical information and authorization requests using evidence-based guidelines and established criteria. Collaborate with healthcare providers to gather necessary documentation. Approve services within scope or refer complex cases to a Medical Director. Manage a high volume of cases in a fast-paced, phone and computer-based environment.

Qualifications

• - REQUIRED Active, unrestricted COMPACT RN license in your state of residence
• 3+ years of clinical nursing experience
• Strong computer skills with the ability to navigate multiple systems
• Ability to work Monday-Friday, 8:00 AM-5:00 PM, with occasional weekend/holiday on-call coverage.
• Associate's degree in Nursing required
• Preferred Prior authorization or utilization management experience Compact RN license BSN

Why Join Us?

• 100% remote opportunity – preference for those residing in Virginia
• Make a clinical impact while enjoying a consistent schedule
• Utilize your nursing expertise in a non-bedside role
• Collaborative, mission-driven healthcare environment

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: $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.

Benefits

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.

Application Deadline

We anticipate the application window for this opening will close on: 10/17/2026.

EEO/DEI

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

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.