Remote RN UM Consultant – Medicare Joint Procedures

CVS Health; Montana; Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

401(k)/retirement options

Wellness programs

Job summary

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role with a Monday–Friday schedule. You’ll review precertifications, apply criteria, and coordinate care to ensure members receive appropriate treatment.

The position requires an active RN license, 3+ years of RN experience and 1+ year in Med/Surg, plus proficiency with Microsoft Office.

Qualifications

• Active, unrestricted RN license in your state of residence.
• Minimum 3 years RN experience and 1+ year Med/Surg.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).

Responsibilities

• Review and assess clinical information for Medicare precertification (joint procedures).
• Apply evidence-based criteria to make coverage determinations.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to improve care quality and utilisation.
• Support care integration by connecting members to programmes and services.
• Serve as a clinical resource to internal and external partners.

Skills

RN experience

Active RN license

3+ years RN experience

MS Office proficiency

Education

Associate degree in nursing

Tools

Microsoft Office 365

VPN access

EHR portal

Job description

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role with a Monday–Friday schedule. You’ll review precertifications, apply criteria, and coordinate care to ensure members receive appropriate treatment.

The position requires an active RN license, 3+ years of RN experience and 1+ year in Med/Surg, plus proficiency with Microsoft Office.