Remote RN Medicare Utilization Consultant

CVS Health; Town of King (WI); Remote; USD 36,000 - 86,000; Full time

Job summary

CVS Health is hiring an RN Utilization Management Nurse Consultant (Medicare - Joint Procedures) for remote, full-time work. You will review Medicare precertification data, apply criteria, and coordinate care plans to ensure appropriate treatment and utilization.

The role requires an active RN license in your state, 3+ years of RN experience, 1+ year in Med/Surg, and proficiency with Microsoft Office. BSN is a plus and remote-work guidelines apply.

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).
• Associates degree in nursing.

Responsibilities

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

Skills

RN license (active)

RN experience 3+ years

Med/Surg 1+ year

Education

Associates degree in nursing

Tools

Microsoft Office (Outlook, Teams, Excel)

Job description

CVS Health is hiring an RN Utilization Management Nurse Consultant (Medicare - Joint Procedures) for remote, full-time work. You will review Medicare precertification data, apply criteria, and coordinate care plans to ensure appropriate treatment and utilization.

The role requires an active RN license in your state, 3+ years of RN experience, 1+ year in Med/Surg, and proficiency with Microsoft Office. BSN is a plus and remote-work guidelines apply.