Remote RN: Medicare Utilization & Precertification

CVS Health; Central City (KY); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical

Dental

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for a remote, full-time weekend schedule. You will review clinical information to support determinations and coordinate care with providers and teams.

Ideal candidates are detail-oriented RNs with 3+ years of RN experience and 1+ year Med/Surg experience, proficient in Microsoft Office. Training is Monday–Friday, with after training a 4-day weekend schedule, including evenings and holidays.

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).
• Willingness to work required schedule post-training.

Responsibilities

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines, policies, and sound judgment across the care continuum.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to enhance quality, efficiency, and member outcomes.
• Refer members to additional programs and services as appropriate.
• Serve as a clinical resource within utilization/benefit management.

Skills

RN license

RN experience

Detail-oriented

Education

Associate degree

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for a remote, full-time weekend schedule. You will review clinical information to support determinations and coordinate care with providers and teams.

Ideal candidates are detail-oriented RNs with 3+ years of RN experience and 1+ year Med/Surg experience, proficient in Microsoft Office. Training is Monday–Friday, with after training a 4-day weekend schedule, including evenings and holidays.