Remote Medicare Utilization Nurse Consultant

CVS Health; Tallahassee (FL); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess and coordinate care for members. The role requires a registered nurse with at least 3 years of experience and an active license in the resident state.

The position operates in a 24/7 Utilization Management environment with home-based work, and requires strong communication with providers, clinicians, and hospital teams to determine appropriate care and benefits.

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).
• Associates degree required; BSN preferred.

Responsibilities

• Assess, plan, and coordinate healthcare services/benefits for members.
• Apply clinical criteria and guidelines to render coverage determinations or recommendations.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify referral opportunities to integrate with other products or programs.
• Collaborate with internal and external stakeholders in utilization/benefit management.

Skills

RN experience

Active RN license

Med/Surg experience

MS Office skills

Education

Associates degree

BSN preferred

Tools

MedCompass

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess and coordinate care for members. The role requires a registered nurse with at least 3 years of experience and an active license in the resident state.

The position operates in a 24/7 Utilization Management environment with home-based work, and requires strong communication with providers, clinicians, and hospital teams to determine appropriate care and benefits.