Remote Medicare Utilization Nurse Consultant (RN)

CVS Health; Colorado Springs (CO); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. This full-time, remote role supports members and requires an RN license with 3+ years of RN experience, plus Med/Surg background and strong MS Office skills.

The role operates in a 24/7 utilization management environment, with a Monday–Friday schedule and potential evening/holiday hours as part of the 24/7 operation; remote work within state/city of residence is required and corporate HIPAA guidelines

Qualifications

• 3+ years of experience as a Registered Nurse.
• 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 care options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply criteria/guideline to render coverage determinations/recommendations.
• Communicate with providers to facilitate care.
• Identify members for referral opportunities to integrate with other programs.
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to internal and external constituents in utilization/benefit management.

Skills

RN experience

Microsoft Office

Education

Associates degree

BSN preferred

Tools

MedCompass

Microsoft Office (Outlook Teams Excel)

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. This full-time, remote role supports members and requires an RN license with 3+ years of RN experience, plus Med/Surg background and strong MS Office skills.

The role operates in a 24/7 utilization management environment, with a Monday–Friday schedule and potential evening/holiday hours as part of the 24/7 operation; remote work within state/city of residence is required and corporate HIPAA guidelines