Remote Precertification Nurse Consultant

CVS Health Corporation; West Virginia; Hybrid; USD 74,528,000 - 196,446,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement options

Job summary

CVS Health is seeking a remote Precertification Nurse to apply clinical criteria and guidelines for services needing precertification. The role involves collecting and reviewing information from providers, and initiating Medical Director referrals as needed.

Ideal candidates hold an active RN license, 3+ years of nursing experience, and are able to work standard hours with occasional on-call or 10-hour shifts. Home-office setup and HIPAA compliance are required.

Qualifications

• Active RN licensure in home state with at least an Associate's Degree.
• 3+ years of clinical nursing experience.
• Willing to work Monday–Friday 8 am–5 pm with possible weekends/holidays.
• Proficient in using multiple computer systems.
• Ability to work in a fast-paced environment.

Responsibilities

• Review clinical information from providers for precertification.
• Authorize procedures/services or refer to Medical Director as needed.
• Communicate via phone and email in a remote work setting.
• Maintain HIPAA compliance and security.

Skills

RN licensure

Clinical nursing

Microsoft Office 365

Fast-paced environment

Education

Associates degree

BSN preferred

Tools

Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint)

Google Workspace

Job description

CVS Health is seeking a remote Precertification Nurse to apply clinical criteria and guidelines for services needing precertification. The role involves collecting and reviewing information from providers, and initiating Medical Director referrals as needed.

Ideal candidates hold an active RN license, 3+ years of nursing experience, and are able to work standard hours with occasional on-call or 10-hour shifts. Home-office setup and HIPAA compliance are required.