Remote Medicare Utilization RN Consultant

CVS Health; Sacramento (CA); Remote; USD 36,000 - 95,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. You will assess and coordinate care, determine coverage and communicate with providers to optimize patient outcomes. The role requires 3+ years of RN experience, an active RN license, and Med/Surg exposure.

Remote work from home with flexible scheduling and HIPAA compliance. Associates degree is required with BSN preferred. Proficiency in Microsoft Office and MedCompass is beneficial.

Qualifications

• Active RN license in the state of residence.
• About 3+ years of RN experience.
• At least 1 year in Med/Surg.
• Proficiency with Microsoft Office applications.

Responsibilities

• Assess, plan, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care.
• Identify referral opportunities to integrate with programs.
• Promote quality and effective utilization of healthcare services.

Skills

RN licensure

Med/Surg experience

Education

Associates degree

BSN preferred

Tools

Microsoft Office 365

MedCompass

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. You will assess and coordinate care, determine coverage and communicate with providers to optimize patient outcomes. The role requires 3+ years of RN experience, an active RN license, and Med/Surg exposure.

Remote work from home with flexible scheduling and HIPAA compliance. Associates degree is required with BSN preferred. Proficiency in Microsoft Office and MedCompass is beneficial.