Remote RN: Medicare Utilization & Precertification

CVS Health; Clifton (TX); 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

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN), remote and full-time with a weekend schedule after training. You’ll review clinical information for coverage determinations, apply guidelines, and coordinate with care teams to improve member outcomes.

Training hours are weekdays, followed by a 4-day weekend schedule; evenings/holidays required. Qualified candidates hold an active RN license, 3+ years of RN experience including Med/Surg, with

Qualifications

• Active, unrestricted RN license in state of residence
• 3+ years 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

Med/Surg experience

Microsoft Office

Willingness to work schedule

Education

BSN preferred / Associate's required

Tools

Microsoft Office 365

Google Workspace

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN), remote and full-time with a weekend schedule after training. You’ll review clinical information for coverage determinations, apply guidelines, and coordinate with care teams to improve member outcomes.

Training hours are weekdays, followed by a 4-day weekend schedule; evenings/holidays required. Qualified candidates hold an active RN license, 3+ years of RN experience including Med/Surg, with