Remote RN: Medicare Precertification & Care Optimization

CVS Health; Kentucky; Remoto; USD 36.000 - 86.000; Tempo pieno

Vantaggi offerti da questo lavoro

Comprehensive benefits

Remote work

Descrizione del lavoro

CVS Health in Kentucky is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for a remote, full-time weekend schedule. You will review clinical information to support coverage determinations, apply clinical guidelines, and coordinate care with providers and care teams.

Required qualifications include an active, unrestricted RN license, 3+ years of RN experience, and 1+ year Med/Surg experience; proficiency with Microsoft Office (Outlook, Teams, Excel) is also

Competenze

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).

Mansioni

• Review and assess clinical information to support coverage determinations
• Apply clinical guidelines, policies, and sound judgment across the care continuum
• Collaborate with providers and care teams to coordinate treatment plans
• Identify opportunities to enhance quality, efficiency, and member outcomes
• Refer members to additional programs and services as appropriate
• Serve as a clinical resource within utilization/benefit management

Conoscenze

Detail-oriented RN

Microsoft Office

Utilization management

Formazione

Associate’s degree

BSN preferred

Strumenti

Microsoft Office 365

Descrizione del lavoro

CVS Health in Kentucky is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for a remote, full-time weekend schedule. You will review clinical information to support coverage determinations, apply clinical guidelines, and coordinate care with providers and care teams.

Required qualifications include an active, unrestricted RN license, 3+ years of RN experience, and 1+ year Med/Surg experience; proficiency with Microsoft Office (Outlook, Teams, Excel) is also