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 (Medicare / Spine)
Remote | Full-Time | Mon–Fri, 9:00 AM–6:00 PM (local time)
May include evenings, holidays, and occasional 24/7 operational coverage needs
About the Role
Join a collaborative healthcare team as a Utilization Management Nurse Consultant supporting Medicare precertification for complex spine cases. In this role, you’ll use your clinical expertise to evaluate care, guide coverage decisions, and help members receive the right care at the right time.
What You’ll Do
- Review clinical information and apply guidelines to determine coverage decisions
- Collaborate with providers and cross-functional teams to support effective care
- Coordinate services and identify opportunities for care integration and quality improvement
- Provide expert consultation on utilization and benefit management
- Support members across the continuum of care with a focus on outcomes and efficiency
What You Bring - REQUIRED
- Active, unrestricted RN license in the state of residence
- 3+ years of RN experience
- 1+ year of Med/Surg experience
- Proficiency with Microsoft Office (Outlook, Teams, Excel)
Preferred Qualifications
- Prior Authorization or Utilization Management experience
- Managed care and/or Medicare experience
- Ambulatory surgery background
- Experience with MedCompass
Education
- Associate’s degree required | BSN preferred
Why Join Us?
Make a meaningful impact on patient care while working in a dynamic, supportive environment that values your clinical expertise and professional growth.
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
- 1+ year of Med/Surg experience
- Proficiency with Microsoft Office (Outlook, Teams, Excel)
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 — Healthcare coverage is positioned as comprehensive for benefits-eligible colleagues, including medical, dental, and vision with free preventive care and access to virtual care and select no-cost MinuteClinic services. Mental health support is also highlighted with no-cost confidential counseling sessions per issue.
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Retirement Support — Retirement benefits include a 401(k) with a dollar-for-dollar match up to 5% after meeting service and hours requirements. Ownership programs are also offered through an employee stock purchase plan with a stated purchase discount.
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Pay Growth & Progression — A companywide minimum wage floor establishes a baseline that is framed as a positive starting point in some roles and markets. Unionized or high-cost areas are described as having clearer wage scales and step-ups that can materially lift pay over time.
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.
