Remote Nurse Consultant - Medicare Utilization

CVS Health; Yuma (AZ); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role requires an RN with 3+ years of experience and active licensure in the state of residence.

The position involves remote work with a Monday–Friday schedule, some evenings and holidays, and responsibilities around evaluating care plans and coordinating with providers. The candidate should have Med/Surg experience and strong MS Office skills, with a focus on ensuring appropriate healthcare services

Qualifications

• 3+ years of experience as a Registered Nurse
• Active current and unrestricted RN license in state of residence
• 1+ years of Med/Surg experience
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)

Responsibilities

• Utilizes clinical experience to assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services/benefits.
• Gathers clinical information and applies clinical criteria to render coverage determinations/recommendations.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other programs.
• Identifies opportunities to promote quality and efficiency of healthcare services and benefit utilization.
• Consults with internal and external stakeholders in coordination of utilization/benefit management.

Skills

Registered Nurse

Med/Surg experience

Microsoft Office

Education

Associate degree

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role requires an RN with 3+ years of experience and active licensure in the state of residence.

The position involves remote work with a Monday–Friday schedule, some evenings and holidays, and responsibilities around evaluating care plans and coordinating with providers. The candidate should have Med/Surg experience and strong MS Office skills, with a focus on ensuring appropriate healthcare services