Remote Medicare Utilization Nurse Consultant

CVS Health; Santa Fe (NM); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant. You will apply clinical judgment to render coverage determinations and collaborate with providers to facilitate appropriate care and benefits.

Candidates must have an active RN license, 3+ years of RN experience, at least 1 year in Med/Surg, and proficiency with Microsoft Office. This full-time, remote role offers a comprehensive benefits package and holiday/evening schedule.

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

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
• Render coverage determinations/recommendations using clinical criteria, policy and guidelines
• Communicate with providers and other parties to facilitate care/treatment
• Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization
• Consult with internal and external constituents in utilization/benefit management

Skills

RN experience

MS Office proficiency

Education

Associate degree

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant. You will apply clinical judgment to render coverage determinations and collaborate with providers to facilitate appropriate care and benefits.

Candidates must have an active RN license, 3+ years of RN experience, at least 1 year in Med/Surg, and proficiency with Microsoft Office. This full-time, remote role offers a comprehensive benefits package and holiday/evening schedule.