Utilization Management Nurse Consultant

CVS Health

1d•$26 - $62•Remote

About The Position

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.

Requirements

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)
Associate’s degree required

Nice To Haves

Prior Authorization or Utilization Management experience
Managed care and/or Medicare experience
Ambulatory surgery background
Experience with MedCompass
BSN preferred

Responsibilities

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