Utilization Management Nurse Consultant

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)

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–6:00pm 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!

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

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.