Remote RN Quality & Utilization Management Consultant

CVS Health; Kansas City (MO); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess, coordinate, and determine appropriate healthcare services for members. The role emphasizes collaboration with providers to facilitate care and referrals, leveraging clinical guidelines and HIPAA-compliant practices.

The position requires an active RN license, 3+ years of nursing experience, and comfortable use of Microsoft Office tools.

Qualifications

• ~3+ years of RN experience.
• Active, unrestricted RN licensure in state of residence.
• ~1+ year of Med/Surg experience.
• ~1+ year of experience with Microsoft Office applications (Outlook, Teams, Excel).

Responsibilities

• Utilizes clinical experience to assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services/benefits.
• Gathers clinical information and applies guidelines to render coverage determinations.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other products/services.
• Identifies opportunities to promote quality, effectiveness of healthcare services and benefit utilization.

Skills

RN experience

Licensure

Med/Surg

MS Office

Education

Associates degree

BSN preferred

Tools

Microsoft Office

Outlook

Teams

Excel

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess, coordinate, and determine appropriate healthcare services for members. The role emphasizes collaboration with providers to facilitate care and referrals, leveraging clinical guidelines and HIPAA-compliant practices.

The position requires an active RN license, 3+ years of nursing experience, and comfortable use of Microsoft Office tools.