Remote RN: Medicare Utilization Consultant

CVS Health; Heber (UT); Remote; USD 36,000 - 85,000; Full time

Job summary

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant for Medicare joint procedures. This remote, full-time role follows a Monday–Friday schedule with some evenings/holidays, supporting precertification reviews and care coordination to ensure appropriate, timely care.

The position requires an active RN license in the resident state, 3+ years of RN experience, 1+ year Med/Surg, and strong Microsoft Office skills. A BSN is a plus.

Qualifications

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

Responsibilities

• Review and assess clinical information for Medicare precertification (joint procedures).
• Apply evidence-based criteria and clinical judgement to make coverage determinations.
• Collaborate with providers and care teams to coordinate appropriate treatment plans.
• Identify opportunities to improve care quality and optimise healthcare utilisation.
• Support care integration by connecting members to additional programmes and services.
• Serve as a clinical resource to internal and external partners.

Skills

RN License

RN Experience 3+ years

Med/Surg experience

MS Office proficiency

Associate degree in nursing

Education

Associate degree in nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant for Medicare joint procedures. This remote, full-time role follows a Monday–Friday schedule with some evenings/holidays, supporting precertification reviews and care coordination to ensure appropriate, timely care.

The position requires an active RN license in the resident state, 3+ years of RN experience, 1+ year Med/Surg, and strong Microsoft Office skills. A BSN is a plus.