Remote Precertification Nurse Case Manager

4062 Aetna Resources, LLC; North Carolina; Hybrid; USD 54,000 - 130,000; 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 hiring a Precertification Nurse Case Manager to review medical records and determine medical necessity for elective procedures. You will communicate determinations to providers and members and guide members through the health care system with our care management team.

The role requires an active RN license, 3+ years of clinical practice, and the ability to work 8:00 AM–4:30 PM in your local time zone with occasional evening rotation.

Qualifications

• Active, current RN state licensure.
• Must reside within 45 miles to New Albany, OH; Chandler, AZ; or High Point, NC.
• 3+ years of clinical practice experience.
• Ability to work 8:00 AM–4:30 PM local time with occasional evening rotation ~2x/month.
• Position is work from home with possible on-site requirements.
• 2+ years of experience using Microsoft Office Suite.

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 via phone.
• Assess member conditions and plan, implement, and coordinate activities.

Skills

Organizational skills

Multitasking

Communication

Education

Associates degree

BSN preferred

Tools

Microsoft Office Suite

Job description

CVS Health is hiring a Precertification Nurse Case Manager to review medical records and determine medical necessity for elective procedures. You will communicate determinations to providers and members and guide members through the health care system with our care management team.

The role requires an active RN license, 3+ years of clinical practice, and the ability to work 8:00 AM–4:30 PM in your local time zone with occasional evening rotation.