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
40Time Type
Full timePay Range
The typical pay range for this role is:
$26.01 - $62.32This 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.
Skills 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-6:00 PM in your time zone; schedules include holidays and evening hours
- Associate Degree in Nursing
- Utilization Management or Prior Authorization experience
- Managed care background
- Familiarity with MedCompass
- Ambulatory surgery experience
- BSN
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
