Remote Medicare Precertification Utilization Nurse Consultant

CVS Health; Lincoln (NE); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to join a 24/7 operation. The role schedules Monday–Friday, 9:00am–5:30pm in the candidate's time zone, with holidays and evening hours as needed, and requires strong clinical assessment, coordination, and communication with providers to determine coverage.

Requirements include 3+ years RN experience, active RN licensure in home state, 1+ year Med/Surg, and MS Office proficiency.

Qualifications

• 3+ years of experience as a Registered Nurse
• Active, current and unrestricted RN licensure in the state of residence
• 1+ years of Med/Surg experience
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)

Responsibilities

• Utilizes clinical experience to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies criteria to render coverage determinations/recommendations.
• Communicates with providers to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other products/services/programs.
• Identifies opportunities to promote quality and effectiveness of healthcare services.

Skills

Clinical nursing

Communication

Team collaboration

Microsoft Office

Education

Associate's degree

BSN preferred

Tools

MedCompass

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to join a 24/7 operation. The role schedules Monday–Friday, 9:00am–5:30pm in the candidate's time zone, with holidays and evening hours as needed, and requires strong clinical assessment, coordination, and communication with providers to determine coverage.

Requirements include 3+ years RN experience, active RN licensure in home state, 1+ year Med/Surg, and MS Office proficiency.