Utilization Management Nurse Consultant Clinical Precertification RN (Medicare- Complex Spine Team)

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 colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare- Complex Spine Team)

Remote | Full-Time | Weekday Schedule

As a Utilization Management Nurse Consultant Clinical Precertification RN, you will use your clinical expertise to ensure members receive the right care at the right time.

Responsibilities

• 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

Requirements

• 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–5:30 PM in your time zone
• Associate Degree in Nursing

Nice to Have

• Utilization Management or Prior Authorization experience
• Managed care background
• Familiarity with MedCompass
• Ambulatory surgery experience
• BSN preferred

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility

Pay Range

$26.01 - $56.14

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.