Utilization Management Nurse Consultant – Preference Residents

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.

Remote UM Nurse Consultant RN Precertification Nurse (Telework)
Work from anywhere!

We are seeking an experienced Registered Nurse to join our Utilization Management team in a fully remote Precertification Nurse role.

Preference is given to Virginia residents or candidates holding both Virginia and Compact RN licenses.

• Review clinical information and authorization requests using evidence-based guidelines and established criteria
• Collaborate with healthcare providers to gather necessary documentation
• Approve services within scope or refer complex cases to a Medical Director
• Manage a high volume of cases in a fast-paced, phone and computer-based environment

• Active, unrestricted COMPACT RN license in your state of residence
• 3+ years of clinical nursing experience
• Strong computer skills with the ability to navigate multiple systems
• Ability to work Monday-Friday, 8:00 AM-5:00 PM, with occasional weekend/holiday on-call coverage.
• Associate’s degree in Nursing required
• Preferred
• Prior authorization or utilization management experience
• Compact RN license
• BSN

• 100% remote opportunity
• preference for those residing in Virginia
• Make a clinical impact while enjoying a consistent schedule
• Utilize your nursing expertise in a non-bedside role
• Collaborative, mission-driven healthcare environment

You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted. A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.

Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live. The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time). If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

• Device & System Navigation:
  Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools:
  Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling:
  Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security:
  Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support:
  Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth:
  Openness to learning new skills in the future as the workplace environment evolves.

Anticipated…