Remote Medicare Utilization Nurse Consultant

CVS Health; Arizona; Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an RN Utilization Management Nurse Consultant. This full-time role is remote within the state, with a 40-hour work week, primarily Mon-Fri, and includes evening/holiday coverage as needed in a 24/7 operation.

You will assess and coordinate care, render determinations using clinical criteria, and collaborate with providers to optimize benefits and services for members.

Qualifications

• 3+ years of experience as a Registered Nurse.
• Active, current RN licensure in the state of residence.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).
• Prior Authorization or Utilization Management experience is preferred.
• Managed care experience is a plus.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services.
• Render coverage determinations/recommendations along the continuum of care using clinical criteria and guidelines.
• Communicate with providers to facilitate care and treatment.
• Identify referral opportunities to integrate with other products or programs.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult with internal and external stakeholders in utilization/benefit management.

Skills

Registered Nurse

Med/Surg experience

Microsoft Office (Outlook, Teams,Excel

Prior Authorization (experience)

Education

Associates degree

BSN preferred

Tools

MedCompass

Job description

CVS Health is seeking an RN Utilization Management Nurse Consultant. This full-time role is remote within the state, with a 40-hour work week, primarily Mon-Fri, and includes evening/holiday coverage as needed in a 24/7 operation.

You will assess and coordinate care, render determinations using clinical criteria, and collaborate with providers to optimize benefits and services for members.