Remote RN UM Consultant – Medicare Joint Procedures

CVS Health; Montana City (MT); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Flexible schedule

Work from home

Competitive benefits

Job summary

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant to support Medicare joint procedures from a remote, full-time setting. You will review clinical data to determine coverage and collaborate with care teams to plan appropriate treatments.

The role requires active RN licensure, 3+ years of RN experience including 1+ year in Med/Surg, and proficiency with Microsoft Office. A strong focus on quality, compliance, and member care is essential.

Qualifications

• Active, unrestricted RN licence in the state of residence.
• 3+ years of RN experience.
• 1+ year of Med/Surg experience.
• Proficiency in Microsoft Office (Outlook, Teams, Excel)

Responsibilities

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

Skills

Registered Nurse license

RN experience

Med/Surg experience

Microsoft Office

Education

Associate degree in nursing

Tools

Microsoft Office

Job description

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant to support Medicare joint procedures from a remote, full-time setting. You will review clinical data to determine coverage and collaborate with care teams to plan appropriate treatments.

The role requires active RN licensure, 3+ years of RN experience including 1+ year in Med/Surg, and proficiency with Microsoft Office. A strong focus on quality, compliance, and member care is essential.