Remote RN: Precertification & Utilization Consultant

CVS Health; Springfield (IL); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant via remote work in the United States. The role requires RN licensure and 3+ years of nursing experience, with Med/Surg exposure and proficiency in Microsoft Office.

You will assess and coordinate care, determine coverage, and collaborate with providers to optimize healthcare services for members. The position includes varied schedules and holiday/evening hours as part of a 24/7 operation.

Qualifications

• Active, current RN licensure in the state of residence.
• Approximately 3+ years of nursing experience.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office (Outlook, Teams, Excel).

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members.
• Apply clinical criteria, guidelines and judgment to render coverage determinations and recommendations.
• Communicate with providers and other parties to facilitate care and treatment.
• Identify members for referral opportunities and coordinate with other programs.
• Advise internal and external stakeholders in utilization/benefit management.

Skills

RN license

Clinical experience

Office proficiency

Education

Associates degree

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant via remote work in the United States. The role requires RN licensure and 3+ years of nursing experience, with Med/Surg exposure and proficiency in Microsoft Office.

You will assess and coordinate care, determine coverage, and collaborate with providers to optimize healthcare services for members. The position includes varied schedules and holiday/evening hours as part of a 24/7 operation.