Utilization Management Nurse Consultant

CVS Health

Utilization Management Nurse Consultant handling precertification for CVS Health. Involves critical thinking, collecting clinical information, and authorizing procedures according to guidelines.

Posted 5/13/2026full-timeRemote • Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $26 - $69 per hourWebsite

About the role

Key responsibilities & impact

Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification
The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers
Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed

Requirements

What you’ll need

Must have active, current and unrestricted RN licensure in the state of Virginia or multi-state compact licensure
3+ years of clinical experience
proficiency with computer skills which includes navigating multiple systems
Ability to work in a fast-paced environment
Associates degree required
BSN preferred

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical practice guidelinesprecertificationclinical information reviewauthorization proceduresMedical Director referral

Soft Skills

critical thinkingability to work in a fast-paced environment

Certifications

active RN licensuremulti-state compact licensure