Remote Medicare Utilization Nurse Consultant

CVS Health; United States; Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking an experienced Utilization Management Nurse Consultant to work remotely in the United States. The role supports Medicare precertification, assesses clinical information, and renders coverage determinations in collaboration with care teams.

The position requires 3+ years of RN experience, an active RN license, and familiarity with Med/Surg and Microsoft Office. Work schedules include holidays and evenings, with a standard 40-hour week and strong HIPAA compliance.

Qualifications

• 3+ years of experience as a Registered Nurse.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)

Responsibilities

• Assess, plan, implement, coordinate and monitor options to facilitate appropriate healthcare services/benefits for members.
• Render coverage determinations/recommendations using clinical criteria/guidelines.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other programs.
• Consult and lend expertise to utilization/benefit management coordination.

Skills

RN experience

Med/Surg experience

Microsoft Office

Education

Associate degree

BSN preferred

Tools

MedCompass

Job description

CVS Health is seeking an experienced Utilization Management Nurse Consultant to work remotely in the United States. The role supports Medicare precertification, assesses clinical information, and renders coverage determinations in collaboration with care teams.

The position requires 3+ years of RN experience, an active RN license, and familiarity with Med/Surg and Microsoft Office. Work schedules include holidays and evenings, with a standard 40-hour week and strong HIPAA compliance.