Remote Precertification Nurse Consultant

CVS Health Corporation; Tennessee; Hybrid; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Telework RN for precertification review and authorization of procedures based on clinical guidelines. The role involves reviewing provider information, ensuring compliance with HIPAA, and coordinating with Medical Directors as needed.

The ideal candidate holds an active RN license (state of residence), has 3+ years of nursing experience, and can work 8 am–5 pm on weekdays with some on-call weekends/holidays.

Qualifications

• Must have active, current and unrestricted RN licensure in state of residence with at least an Associate's Degree.
• 3+ years of clinical experience in nursing.
• Must be willing and able to work Monday - Friday 8 am - 5 pm with occasional weekend/holiday on-call or rotating 10 hour shifts.
• Proficient computer skills which include navigating multiple systems.
• Ability to work in a fast-paced environment.

Responsibilities

• Apply precertification criteria and clinical practice guidelines for services requiring precertification.
• Review clinical information from providers and authorize procedures/services as required.
• Initiate Medical Director referrals when needed.
• Work from home in a designated private, secure home office that complies with HIPAA.

Skills

Clinical nursing

Computer proficiency

Fast-paced environment

Communication

Education

Associate's degree

BSN preferred

Tools

MS Office 365 Suite

Teams

Outlook

Word

Excel

PowerPoint

Google Workspace

Job description

CVS Health is seeking a Telework RN for precertification review and authorization of procedures based on clinical guidelines. The role involves reviewing provider information, ensuring compliance with HIPAA, and coordinating with Medical Directors as needed.

The ideal candidate holds an active RN license (state of residence), has 3+ years of nursing experience, and can work 8 am–5 pm on weekdays with some on-call weekends/holidays.