Remote Medicare Utilization Management RN Consultant

CVS Health; Annapolis (MD); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. Schedule is Monday–Friday, 9:00am–5:30pm in the candidate's time zone, with 24/7 operations including holidays and evening hours.

Responsibilities include assessing, planning, coordinating and recommending care, using clinical criteria to determine coverage, and collaborating with providers. Ideal candidates hold ~3+ years RN experience, active RN license, and ~1+ years Med/Surg and Microsoft Office

Qualifications

• ~3+ years of experience as a Registered Nurse
• Must have active current and unrestricted RN licensure in 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 for appropriate healthcare services/benefits
• Gathers clinical information and applies criteria/guideline to render coverage determination/recommendation
• Communicates with providers to facilitate care/treatment
• Identifies members for referral opportunities and integration with other programs
• Lends expertise to coordination and administration of utilization/benefit management

Skills

RN

Utilization Management

Communication with providers

Clinical assessment

Education

Associates degree

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. Schedule is Monday–Friday, 9:00am–5:30pm in the candidate's time zone, with 24/7 operations including holidays and evening hours.

Responsibilities include assessing, planning, coordinating and recommending care, using clinical criteria to determine coverage, and collaborating with providers. Ideal candidates hold ~3+ years RN experience, active RN license, and ~1+ years Med/Surg and Microsoft Office