Remote Medicare Precertification RN

CVS Health; Virginia; A distancia; USD 36.000 - 86.000; Jornada completa

Descripción de la vacante

CVS Health seeks a Utilization Management Nurse Consultant (RN) to review clinical cases and determine coverage using evidence-based guidelines, coordinating treatment with providers and care teams.

Required are an active RN license, 3+ years of RN experience (including Med/Surg), and proficiency with Microsoft Office. The role is remote, full-time with a Monday–Friday schedule in your time zone, with potential holiday hours.

Formación

• Active, unrestricted RN license in the state of residence.
• 3+ 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.
• Associate Degree in Nursing.

Responsabilidades

• Review clinical cases and make coverage determinations using evidence-based guidelines.
• Collaborate with providers and care teams to coordinate appropriate treatment.
• 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.

Conocimientos

RN license

Clinical assessment

Microsoft Office proficiency

Weekday schedule availability

Educación

Associate Degree in Nursing

Herramientas

Microsoft Office

Descripción del empleo

CVS Health seeks a Utilization Management Nurse Consultant (RN) to review clinical cases and determine coverage using evidence-based guidelines, coordinating treatment with providers and care teams.

Required are an active RN license, 3+ years of RN experience (including Med/Surg), and proficiency with Microsoft Office. The role is remote, full-time with a Monday–Friday schedule in your time zone, with potential holiday hours.