Remote RN: Medicare Utilization Management Consultant

CVS Health; Charlotte (NC); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role is full-time and based in a remote-capable environment within the United States, requiring active RN licensure, 3+ years of RN experience, and Med/Surg experience.

Schedule is Monday–Friday, with evenings/holidays as needed, in the candidate's time zone. The position focuses on clinical assessment, applying criteria to determine coverage, coordinating care with providers, and identifying

Qualifications

• 3+ years of experience as a Registered Nurse
• Must have active current and unrestricted RN licensure in state of residence
• 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 healthcare options for members
• Render coverage determinations/recommendations using clinical criteria and guidelines
• Communicate with providers to facilitate care/treatment
• Identify referral opportunities to integrate with other CVS programs
• Support the utilization/benefit management function

Skills

RN experience

RN licensure

Med/Surg experience

MS Office (Outlook)

MS Office (Teams)

MS Office (Excel)

Education

Associates degree

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role is full-time and based in a remote-capable environment within the United States, requiring active RN licensure, 3+ years of RN experience, and Med/Surg experience.

Schedule is Monday–Friday, with evenings/holidays as needed, in the candidate's time zone. The position focuses on clinical assessment, applying criteria to determine coverage, coordinating care with providers, and identifying