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.
Medicare Precertification Utilization Management Nurse Consultant (Remote)
Schedule: Monday–Friday, 9:00 AM – 6:00 PM (local time); includes occasional evenings, holidays, and participation in a 24/7 operation.
About the Role
We’re seeking a Registered Nurse (RN) with strong clinical judgment to join our Utilization Management team. In this role, you’ll help ensure members receive appropriate, high-quality, and cost-effective care by reviewing clinical information, making coverage determinations, and collaborating with providers and care teams.
What You’ll Do
Review and assess clinical information using established guidelines and criteria
Make coverage determinations across the continuum of care
Collaborate with providers and internal partners to coordinate care
Identify opportunities to improve care quality and utilization outcomes
Refer members to programs and services that support better health outcomes
Serve as a clinical resource for internal and external stakeholders
Required Qualifications
Active, unrestricted RN license in state of residence
3+ years of RN experience
1+ year of Med/Surg experience
Proficiency with Microsoft Office (Outlook, Teams, Excel)
Associate’s degree in nursing (BSN preferred)
Preferred Qualifications
Utilization Management or Prior Authorization experience
Managed care and/or Medicare experience
Experience with MedCompass
Ambulatory surgery experience
This is a great opportunity for an RN looking to leverage clinical expertise in a collaborative, non-bedside role that impacts patient care at scale.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$26.01 - $68.55
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: 06/06/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Apply To This Job
Medicare Precertification Utilization Management Nurse Consultant (Remote)
Schedule: Monday–Friday, 9:00 AM – 6:00 PM (local time); includes occasional evenings, holidays, and participation in a 24/7 operation.
About the Role
We’re seeking a Registered Nurse (RN) with strong clinical judgment to join our Utilization Management team. In this role, you’ll help ensure members receive appropriate, high-quality, and cost-effective care by reviewing clinical information, making coverage determinations, and collaborating with providers and care teams.
What You’ll Do
Review and assess clinical information using established guidelines and criteria
Make coverage determinations across the continuum of care
Collaborate with providers and internal partners to coordinate care
Identify opportunities to improve care quality and utilization outcomes
Refer members to programs and services that support better health outcomes
Serve as a clinical resource for internal and external stakeholders
Required Qualifications
Active, unrestricted RN license in state of residence
3+ years of RN experience
1+ year of Med/Surg experience
Proficiency with Microsoft Office (Outlook, Teams, Excel)
Associate’s degree in nursing (BSN preferred)
Preferred Qualifications
Utilization Management or Prior Authorization experience
Managed care and/or Medicare experience
Experience with MedCompass
Ambulatory surgery experience
This is a great opportunity for an RN looking to leverage clinical expertise in a collaborative, non-bedside role that impacts patient care at scale.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$26.01 - $68.55
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: 06/06/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Apply To This Job