Remote Medicare Utilization Nurse Consultant

CVS Health; Lexington (KY); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, vision

Bonus/ incentives

Wellness programs

Job summary

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant. The role involves assessing care options, applying clinical criteria, and coordinating with providers to ensure appropriate services are delivered.

Requires RN licensure and 3+ years of nursing experience, with Med/Surg and MS Office skills preferred. The position is full-time with a schedule Monday–Friday; work-from-home options may apply within state requirements.

Qualifications

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

Responsibilities

• Assess and coordinate care to facilitate appropriate healthcare services/benefits
• Gather clinical information and apply criteria to render coverage determinations
• Communicate with providers to facilitate care/treatment
• Identify referral opportunities to integrate with other programs
• Consult with internal/external stakeholders in utilization/benefit management

Skills

RN experience

MS Office (Outlook/Teams/Excel)

Med/Surg experience

Education

Associates degree

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant. The role involves assessing care options, applying clinical criteria, and coordinating with providers to ensure appropriate services are delivered.

Requires RN licensure and 3+ years of nursing experience, with Med/Surg and MS Office skills preferred. The position is full-time with a schedule Monday–Friday; work-from-home options may apply within state requirements.