Remote Medicare Utilization Nurse Consultant

CVS Health; Baton Rouge (LA); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical benefits

Dental insurance

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant. This full-time role requires RN licensure in the resident state and 3+ years of RN experience, including Med/Surg.

The position focuses on coordinating and evaluating care, and applying clinical criteria to determine coverage, while collaborating with providers to optimize benefits. This remote-friendly opportunity supports a 9:00am–5:30pm schedule in the candidate's time zone, with 24/7 coverage for

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 to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies criteria to render coverage determinations/recommendations.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other products/services.
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of utilization/benefit management.

Skills

RN licensure

Clinical nursing experience

Healthcare coordination

Education

Associates degree required

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant. This full-time role requires RN licensure in the resident state and 3+ years of RN experience, including Med/Surg.

The position focuses on coordinating and evaluating care, and applying clinical criteria to determine coverage, while collaborating with providers to optimize benefits. This remote-friendly opportunity supports a 9:00am–5:30pm schedule in the candidate's time zone, with 24/7 coverage for