Remote Medicare Utilization Nurse Consultant

CVS Health; Madison (WI); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role involves assessing and coordinating care, applying clinical guidelines, and communicating with providers to determine coverage and initiate referrals. A strong RN background and Med/Surg experience are required.

The position supports a remote, full-time schedule with strict home-office requirements and a base hourly pay range, plus bonus eligibility.

Qualifications

• 3+ years of experience as a Registered Nurse.
• Active RN license in the state of residence.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office apps.

Responsibilities

• Assess, plan, implement, coordinate, and evaluate options to facilitate appropriate healthcare services.
• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care and treatment.
• Identify members for referral opportunities to integrate services and programs.
• Promote quality and effectiveness of healthcare services and benefit utilization.
• Consult with internal/external constituents in utilization/benefit management.

Skills

RN experience

Med/Surg experience

Clinical assessment

Education

Associate degree

BSN preferred

Tools

MedCompass

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role involves assessing and coordinating care, applying clinical guidelines, and communicating with providers to determine coverage and initiate referrals. A strong RN background and Med/Surg experience are required.

The position supports a remote, full-time schedule with strict home-office requirements and a base hourly pay range, plus bonus eligibility.