Remote Medicare Utilization Nurse Consultant

CVS Health

Montgomery (AL)

Remote

USD 36,000 - 94,000

Full time

6 days ago

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Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant. The role supports a 24/7 operation with holidays and evenings, following a Monday–Friday schedule from 9:00am to 5:30pm in the candidate's time zone.

The job emphasizes RN clinical experience to assess and coordinate patient care and benefits for members. Responsibilities include applying criteria to determine coverage, communicating with providers, and identifying referral opportunities within the

Qualifications

3+ years of experience as a registered nurse.
Active RN licensure in state of residence.
1+ years of Med/Surg experience.
1+ years of experience with Microsoft Office applications.

Responsibilities

Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members.
Gather clinical information and apply clinical criteria to render coverage determinations.
Communicate with providers to facilitate care and treatment.
Identify members for referral opportunities and program integration.
Consult with internal/external stakeholders in utilization/benefit management.