# Utilization Management Nurse Consultant Clinical Precertification RN (Medicare Home Care)

**Company**: CVS Health
**Location**: Work from home, FL
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $29.10 - $62.32
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/FL---Work-from-home/Utilization-Management-Nurse-Consultant_R1037288?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_d1fbd8e8-3bc

## Description

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 Home Care)**

**Remote | Full-Time | Weekday Schedule**

Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and 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 home care providers, attending MDs and care teams to coordinate a smooth transition of care from a hospital and/or post-acute setting to home care

- 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

- 2+ 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–6:00 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours

- Associate Degree in Nursing

**Preferred Qualifications**

- Utilization Management or Prior Authorization experience

- Managed care background

- Home health experience

- BSN preferred

**Benefits**

- Transition your clinical skills into a collaborative, non-bedside role

- Make a meaningful impact on patient care and outcomes

- Work in a supportive, team-driven environment

- Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources

**Anticipated Weekly Hours** 40

**Time Type** Full time

**Pay Range** $29.10 - $62.32

## Skills

### Required
- RN license
- Microsoft Office
- clinical assessment
- decision-making

### Nice to have
- Utilization Management
- Prior Authorization
- Managed care
- Home health
- BSN

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/FL---Work-from-home/Utilization-Management-Nurse-Consultant_R1037288?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)