Remote RN: Medicare Utilization & Precertification Consultant

CVS Health; Montgomery (AL); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess and coordinate care for members from a home-based location. The role requires clinical expertise in Utilization Management and collaboration with providers to ensure appropriate services and benefit utilization.

The position emphasizes strong communication, documentation, and adherence to HIPAA guidelines, with a 9:00–5:30 schedule in the candidate’s time zone and inclusion of holidays and

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

• Utilizes clinical experience to assess, plan, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits.
• Gathers clinical information and applies criteria, policy and clinical judgment to render coverage determinations.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other programs.
• Identifies opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Consults with internal and external constituents in coordination and administration of utilization/benefit management.

Skills

RN experience

Microsoft Office

Education

Associates degree

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess and coordinate care for members from a home-based location. The role requires clinical expertise in Utilization Management and collaboration with providers to ensure appropriate services and benefit utilization.

The position emphasizes strong communication, documentation, and adherence to HIPAA guidelines, with a 9:00–5:30 schedule in the candidate’s time zone and inclusion of holidays and