Remote RN Utilisation Management Consultant (Medicare)

CVS Health; Arkansas City (KS); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programmes

Job summary

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant to support Medicare joint procedures in a remote, full-time capacity. You will review clinical information, apply criteria, coordinate care plans, and collaborate with providers to ensure appropriate care and utilisation, while staying compliant with HIPAA and CVS standards.

Ideal candidates have an active RN license, 3+ years of RN experience, 1+ year in Med/Surg, and strong MS Office skills; BSN or further

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).
• Associate degree in nursing.

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

RN licence

RN experience

Med/Surg experience

Microsoft Office

Associate degree in nursing

Education

Associate degree in nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant to support Medicare joint procedures in a remote, full-time capacity. You will review clinical information, apply criteria, coordinate care plans, and collaborate with providers to ensure appropriate care and utilisation, while staying compliant with HIPAA and CVS standards.

Ideal candidates have an active RN license, 3+ years of RN experience, 1+ year in Med/Surg, and strong MS Office skills; BSN or further