Remote RN: Medicare Utilization Consultant

CVS Health; Montpelier (VT); Remote; USD 36,000 - 95,000; Full time

Benefits offered by this job

Medical benefits

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The schedule is Monday–Friday, 9:00am–5:30pm in the candidate’s time zone. This is a work-from-home role in a 24/7 operation with holiday/evening hours.

The position requires ~3+ years as an RN, active RN licensure, ~1+ year Med/Surg, and strong MS Office skills. Associates degree is required; BSN preferred. Remote work within the home state with company-provided equipment.

Qualifications

• Active RN licensure in state of residence.
• ~3+ years of RN experience.
• ~1+ years of Med/Surg experience.
• ~1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other programs.
• Consult and lend expertise to coordination of utilization/benefit management.

Skills

Registered Nurse

Med/Surg experience

Microsoft Office familiarity

Education

Associates degree

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The schedule is Monday–Friday, 9:00am–5:30pm in the candidate’s time zone. This is a work-from-home role in a 24/7 operation with holiday/evening hours.

The position requires ~3+ years as an RN, active RN licensure, ~1+ year Med/Surg, and strong MS Office skills. Associates degree is required; BSN preferred. Remote work within the home state with company-provided equipment.