Utilization Management Nurse Consultant

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.

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.

• 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

• 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)

• Prior Authorization or Utilization Management experience
• Managed care and/or Medicare experience
• Ambulatory surgery background
• Experience with Med Compass

• Associate’s degree required | BSN preferred

Make a meaningful impact on patient care while working in a dynamic, supportive environment that values your clinical expertise and professional growth.

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The typical pay range for this role is: $26.01 – $62.32. 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.

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.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.