Utilization Management Nurse Consultant (Work From Home)

CVS Health Corporation; United States; Remote; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking a Utilization Management Nurse Consultant for Medicare Home Care. This remote, full-time role supports Florida members and partners with care teams to ensure appropriate care. You will review cases, make coverage determinations, and coordinate transitions from hospital to home care, using evidence-based guidelines.

40 hours/week, with holidays and evening hours as needed. Required: active, unrestricted RN license in your state, 2+ years RN experience (1+ year

Qualifications

• Active RN license in the state of residence.
• 2+ years RN experience, including 1+ year in Med/Surg.
• Strong clinical assessment and decision-making skills.
• Experience with Microsoft Office (Outlook, Teams, Excel).
• Associates degree in Nursing required.

Responsibilities

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

Skills

RN license

Clinical assessment

Decision-making

Microsoft Office

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office Suite

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 ourselvesaccountable 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 Home Care)

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. This is an exciting new role supporting home care requests for Florida Medicare members.

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 a smooth transition of care from a hospital and/or post-acute setting to home 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

What You Bring - REQUIRED

• Active, unrestricted RN license in the state of residence.
• 2+ 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–6:00 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

Preferred Qualifications

• Utilization Management or Prior Authorization experience
• Managed care background
• Home health 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!

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.

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

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.

We anticipate the application window for this opening will close on: 10/21/2026

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