Remote Precertification Nurse Case Manager

CVS Health Corporation; New Albany, Chandler, High Point (OH, AZ, NC); Remote; USD 36,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Precertification Nurse Case Manager to support remote operations while meeting a 40-hour work week. You will review records to assess medical necessity, coordinate with care teams, and communicate decisions to providers and members as part of a high-quality, cost-conscious care program.

Requires active RN license, 3+ years of clinical practice, and the ability to work across time zones from home with occasional on-site requirements near New Albany, OH, Chandler, AZ or

Qualifications

• Active, current and unrestricted RN licensure in applicable state(s).
• 3+ years of clinical practice experience required.
• Proficiency with Microsoft Office Suite (Teams, Outlook, Word, Excel).
• Associates degree required; BSN preferred.

Responsibilities

• Review medical records to determine medical necessity for elective procedures.
• Communicate current status and determinations to providers and members.
• Coordinate care with the care management team and guide members through the health care system.
• Apply utilization management principles using CPB, MCG and evidence-based criteria.
• Collaborate with providers, multidisciplinary teams, and payers to optimize patient outcomes.

Skills

Active RN license

Clinical practice

Microsoft Office

Education

Associate degree

BSN preferred

Tools

Microsoft Office Suite

Job description

CVS Health is seeking a Precertification Nurse Case Manager to support remote operations while meeting a 40-hour work week. You will review records to assess medical necessity, coordinate with care teams, and communicate decisions to providers and members as part of a high-quality, cost-conscious care program.

Requires active RN license, 3+ years of clinical practice, and the ability to work across time zones from home with occasional on-site requirements near New Albany, OH, Chandler, AZ or