Remote RN Utilisation Management Consultant – Medicare

CVS Health; Eagle (ID); Remote; USD 36,000 - 85,000; Full time

Job summary

CVS Health is seeking an RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. You will review clinical information for precertifications, apply criteria, and collaborate with care teams to ensure appropriate treatment plans. A strong RN background with Med/Surg experience is required.

This role offers a weekday schedule with occasional evenings/holidays and the opportunity to impact care quality through utilization management.

Qualifications

• Active, unrestricted RN license 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 license

RN experience

Med/Surg experience

MS Office

Education

Associate degree in nursing

Job description

CVS Health is seeking an RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. You will review clinical information for precertifications, apply criteria, and collaborate with care teams to ensure appropriate treatment plans. A strong RN background with Med/Surg experience is required.

This role offers a weekday schedule with occasional evenings/holidays and the opportunity to impact care quality through utilization management.