Remote RN Utilisation Management Consultant – Medicare

CVS Health; Alaska; Remoto; USD 36.000 - 86.000; Tempo pieno

Descrizione del lavoro

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. The position coordinates care, reviews clinical data for precertifications, and applies evidence-based criteria to determine coverage decisions.

Responsibilities include collaboration with providers, care teams, and internal partners to optimise utilization and ensure appropriate treatment plans are implemented.

Competenze

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

Mansioni

• 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 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.

Conoscenze

RN Licensure

RN Experience

Med/Surg Experience

Office Proficiency

Formazione

Associate degree in nursing

Strumenti

Microsoft Office

Descrizione del lavoro

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. The position coordinates care, reviews clinical data for precertifications, and applies evidence-based criteria to determine coverage decisions.

Responsibilities include collaboration with providers, care teams, and internal partners to optimise utilization and ensure appropriate treatment plans are implemented.