Remote RN: Medicare Utilization & Precertification

CVS Health; Illinois; Remote; USD 36,000 - 85,000; Full time

Benefits offered by this job

Benefits package

Bonus eligibility

Job summary

CVS Health is seeking an experienced Registered Nurse for Medicare Precertification Utilization Management in a remote, full-time weekend schedule. The role emphasizes ensuring appropriate care, coordinating with providers, and applying guidelines to support coverage determinations.

The position requires an active RN license, 3+ years of RN experience, and Med/Surg exposure. Proficiency in Microsoft Office and flexibility with post-training hours are essential.

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.

Education

RN license (Active, unrestricted)

Associate’s degree

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is seeking an experienced Registered Nurse for Medicare Precertification Utilization Management in a remote, full-time weekend schedule. The role emphasizes ensuring appropriate care, coordinating with providers, and applying guidelines to support coverage determinations.

The position requires an active RN license, 3+ years of RN experience, and Med/Surg exposure. Proficiency in Microsoft Office and flexibility with post-training hours are essential.