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 | Monday-Friday
Are you a Registered Nurse looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive the right care, at the right time, in the right setting.
What You'll Do
- Review clinical cases and make coverage determinations using evidence-based criteria
- Collaborate with providers and interdisciplinary care teams to support treatment planning
- Apply clinical judgment to utilization management and prior authorization decisions
- Identify opportunities to improve quality, outcomes, and member experience
- Serve as a trusted clinical resource for internal and external stakeholders
Required Qualifications
- Active, unrestricted RN license in the state of residence
- Minimum 3 years of RN experience
- Strong clinical assessment, critical thinking, and decision-making skills
- Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel
- Associate Degree in Nursing (ADN)
- Ability to work Monday-Friday, 9:00 AM-5:30 PM in your local time zone
- Utilization Management is a 24/7 operation. Schedules may include occasional evenings, weekends, and holidays based on business needs.
- Work-from-Home Requirements
- Direct wired internet connection (minimum 25 Mbps download / 3 Mbps upload); Wi-Fi and satellite internet are not permitted
- Dedicated, private workspace that complies with HIPAA and company security requirements
- Ability to work from your confirmed state and city of residence
- Company-provided equipment includes computer, monitor(s), keyboard, and headset
- Employees are responsible for providing appropriate workspace furniture
- Commitment to maintaining required internet speeds and remote work standards
Preferred Qualifications
- Utilization Management, Prior Authorization, or Care Management experience
- 1 year in Medical-Surgical Nursing
- Managed care experience
- Experience using MedCompass or similar UM platforms
- Ambulatory surgery or outpatient clinical experience
- Bachelor of Science in Nursing (BSN)
Technical Requirements
- Ability to navigate multiple monitors and applications simultaneously
- Comfortable using Teams, Outlook, email, calendars, and virtual meeting platforms
- Experience with Microsoft 365 applications (Teams, Outlook, Word, Excel, PowerPoint) or similar tools
- Ability to securely access systems, including VPNs and healthcare applications
- Basic troubleshooting skills, including resolving connectivity and application issues
- Willingness to learn new technology and adapt to evolving business needs
If you're passionate about combining clinical expertise, healthcare quality, and care coordination to improve member outcomes, we'd love to hear from you.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$29.10 - $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
- Minimum 3 years of RN experience
- Strong clinical assessment, critical thinking, and decision-making skills
- Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel
- Associate Degree in Nursing (ADN)
- Ability to work Monday-Friday, 9:00 AM-5:30 PM in the local time zone
- Ability to work occasional evenings, weekends, and holidays based on business needs
- Direct wired internet connection with minimum 25 Mbps download and 3 Mbps upload speeds
- Dedicated private workspace complying with HIPAA and company security requirements
- Ability to work from the confirmed state and city of residence
- Utilization Management, Prior Authorization, or Care Management experience
- One year of Medical-Surgical Nursing experience
- Managed care experience
- Experience using MedCompass or similar utilization management platforms
- Ambulatory surgery or outpatient clinical experience
- Bachelor of Science in Nursing (BSN)
- Ability to navigate multiple monitors and applications simultaneously
- Experience with Microsoft 365 applications or similar tools
- Ability to securely access systems, including VPNs and healthcare applications
- Basic troubleshooting skills for connectivity and application issues
- Willingness to learn new technology and adapt to evolving business needs
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
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.
