Remote RN Utilisation Management Consultant (Medicare)

CVS Health; Iowa; Remote; USD 36,000 - 85,000; Full time

Job summary

CVS Health is seeking an experienced RN for Utilisation Management (Medicare – Joint Procedures) in a remote, full-time capacity. The role focuses on ensuring members receive the right care at the right time through precertification review and collaboration with care teams.

The RN will require an active license in the state of residence, 3+ years of RN experience, 1+ year in Med/Surg, and strong Office skills. A remote work setup with strict HIPAA compliance is required.

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.

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 experience

Office software proficiency

Education

Associate degree in nursing

Tools

Microsoft Office

Job description

CVS Health is seeking an experienced RN for Utilisation Management (Medicare – Joint Procedures) in a remote, full-time capacity. The role focuses on ensuring members receive the right care at the right time through precertification review and collaboration with care teams.

The RN will require an active license in the state of residence, 3+ years of RN experience, 1+ year in Med/Surg, and strong Office skills. A remote work setup with strict HIPAA compliance is required.