Remote Medicare Utilization Nurse Consultant

CVS Health; Phoenix (AZ); Remote; USD 36,000 - 94,000; Full time

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 remote in the United States. The role requires ~3+ years of RN experience, active RN license, and 1+ year Med/Surg, plus proficiency with Microsoft Office (Outlook, Teams, Excel).

The schedule is Monday–Friday, with holiday/evening shifts as needed for a 24/7 UM operation. You will assess, coordinate and determine coverage, communicate with providers, and identify opportunities to optimize the utilization of

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 and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other products, services and/or programs.
• 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 the utilization/benefit management function.

Skills

RN experience

Education

Associates degree

BSN preferred

Tools

Outlook

Teams

Excel

Microsoft Office 365

Job description

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant remote in the United States. The role requires ~3+ years of RN experience, active RN license, and 1+ year Med/Surg, plus proficiency with Microsoft Office (Outlook, Teams, Excel).

The schedule is Monday–Friday, with holiday/evening shifts as needed for a 24/7 UM operation. You will assess, coordinate and determine coverage, communicate with providers, and identify opportunities to optimize the utilization of