Utilization Management Nurse Consultant (Work From Home)

CVS Health Corporation; Town of Florida (NY); Remote; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant for a remote Florida-based role focused on Medicare members. The position emphasizes clinical review, collaboration with home care teams, and evidence-based determinations to optimize care and efficiency.

Required RN licensure with 2+ years of experience, including Med/Surg and utilization management exposure. Benefits include medical/dental/vision, PTO, and retirement options, with a weekday full-time schedule.

Qualifications

• RN experience and clinical knowledge in utilization management.
• Med/Surg background helps in coverage determinations.
• Prior Authorization experience is a plus.
• Home health exposure supports transitions of care.

Responsibilities

• Review clinical cases and make coverage determinations using guidelines.
• Collaborate with home care providers, attending MDs, and care teams.
• Apply clinical judgment to support utilization and benefit decisions.
• Identify opportunities to improve care quality and member outcomes.

Skills

RN experience

Med/Surg experience

Utilization Management experience

Prior Authorization experience

Home health experience

Education

Associate Degree in Nursing

BSN preferred

Job description

About This Role

The Utilization Management Nurse Consultant role at CVS Health is designed for Registered Nurses looking to leverage their clinical expertise in a non-bedside position. This remote position focuses on supporting home care requests for Florida Medicare members.

Highlights

• Pay: $29.10 - $62.32/hour
• Location: Remote, FL
• Schedule: Full-time, Weekday Schedule

What You’ll Do

• Review clinical cases and make coverage determinations using evidence-based guidelines.
• Collaborate with home care providers, attending MDs, and care teams to coordinate transitions of care.
• 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.

Requirements

• Education:
  • Associate Degree in Nursing required, BSN preferred.
• Experience:
  • 2+ years of RN experience, including 1+ year in Med/Surg.
  • Utilization Management or Prior Authorization experience preferred.
  • Managed care background preferred.
  • Home health experience preferred.
• Licenses & Certifications:
  • Active, unrestricted RN license in the state of residence required.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They prioritize safety and quality in everything they do, aiming to simplify healthcare for individuals and communities.