<p>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 <span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">ourselves accountable</span> 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.</p><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p><b>Medicare Precertification Utilization Management Nurse Consultant (RN)</b></p><p><b>Remote | Full-Time | Weekends</b></p><p>Are you a detail-oriented RN passionate about improving healthcare outcomes? Join our Utilization Management team and play a key role in ensuring members receive the right care at the right time.</p><p><b>What You’ll Do</b></p><ul><li>Review and assess clinical information to support coverage determinations</li><li>Apply clinical guidelines, policies, and sound judgment across the care continuum</li><li>Collaborate with providers and care teams to coordinate treatment plans</li><li>Identify opportunities to enhance quality, efficiency, and member outcomes</li><li>Refer members to additional programs and services as appropriate</li><li>Serve as a clinical resource within utilization/benefit management</li></ul><p><b>Schedule</b></p><ul><li>Training: Monday–Friday, 8:30 AM–5:00 PM (EST)</li><li>After training: 4-day <b>WEEKEND</b> schedule (Friday–Monday, 10-hour shifts)</li><li>Includes evening hours and occasional holidays (24/7 operation)</li></ul><p><b>Required Qualifications</b></p><ul><li>Active, unrestricted RN license in state of residence</li><li>3+ years of RN experience</li><li>1+ year Med/Surg experience</li><li>Proficiency with Microsoft Office (Outlook, Teams, Excel)</li><li>Willingness to work required schedule post-training</li></ul><p><b>Preferred Qualifications</b></p><ul><li>Prior Authorization or Utilization Management experience</li><li>Managed care experience</li><li>MedCompass experience</li><li>Ambulatory surgery background</li><li>BSN preferred (Associate’s required)</li></ul><div></div><p><b>Why Join Us?</b><br>Be part of a collaborative team that truly impacts patient care while enjoying a structured schedule and opportunities for professional growth.</p><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:left"><b><span>Anticipated Weekly Hours</span></b></p>40<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:left"><b>Time Type</b></p>Full time<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:left"><b>Pay Range</b></p><p style="text-align:left">The typical pay range for this role is:</p><p style="text-align:inherit"></p>$26.01 - $62.32<p style="text-align:inherit !important"></p><p style="text-align:left !important">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. <br> </p><p style="text-align:left !important">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.</p><p style="text-align:inherit !important"></p><p><b>Great benefits for great people</b></p><p></p><p>We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.<br><br></p>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.<p><span style="color:#4a4a4a"><br>Additional details about available benefits are provided during the application process and on </span><a href="https://learn.bswift.com/cvshealth-mainland" target="_blank" rel="noopener noreferrer"><span style="color:#0000ff"><u>Benefits Moments</u></span></a><span style="color:#4a4a4a">.<br><br></span></p>We anticipate the application window for this opening will close on: 06/13/2026<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:left">Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p>