Remote RN: Medicare Utilization Management Consultant

CVS Health; Alton (IL); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. This role applies clinical expertise to assess, plan, and coordinate healthcare services and benefits for members to ensure appropriate care across the continuum.

You will gather clinical information, apply criteria and guidelines, render coverage determinations, and communicate with providers. The position requires RN licensure and 3+ years of experience, with a full-time remote work arrangement.

Qualifications

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

Responsibilities

• Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits.
• Gather clinical information and apply criteria/guidelines to render coverage determinations.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referrals to integrate with other programs.
• Consult and lend expertise to UM coordination and administration.

Skills

RN experience

Med/Surg

Microsoft Office

Education

Associates degree

BSN

Tools

MedCompass

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. This role applies clinical expertise to assess, plan, and coordinate healthcare services and benefits for members to ensure appropriate care across the continuum.

You will gather clinical information, apply criteria and guidelines, render coverage determinations, and communicate with providers. The position requires RN licensure and 3+ years of experience, with a full-time remote work arrangement.