Remote Medicare Utilization Nurse Consultant

CVS Health; Little Rock (AR); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role uses clinical experience to assess, plan, coordinate and evaluate options to ensure appropriate healthcare services for members.

You will gather clinical data, apply guidelines, and render coverage determinations while communicating with providers to support patient care. The position requires RN licensure, 3+ years of nursing experience (Med/Surg preferred), and comfort with Microsoft Office

Qualifications

• 3+ years of experience as a Registered Nurse.
• Active, current, 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

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply clinical criteria/guideline to render coverage determination/recommendation.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other products, services and/or programs.
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Lend expertise to internal and external constituents in utilization/benefit management.

Skills

RN experience

Med/Surg experience

Education

Associate degree

BSN

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role uses clinical experience to assess, plan, coordinate and evaluate options to ensure appropriate healthcare services for members.

You will gather clinical data, apply guidelines, and render coverage determinations while communicating with providers to support patient care. The position requires RN licensure, 3+ years of nursing experience (Med/Surg preferred), and comfort with Microsoft Office