Remote RN Utilisation Management Consultant (Medicare)

CVS Health; North Carolina; Remote; USD 36,000 - 86,000; Full time

Job summary

CVS Health is seeking a Remote RN Utilisation Management Nurse Consultant for Medicare joint procedures. The role focuses on evaluating clinical information, applying evidence-based criteria, and coordinating care with providers to ensure appropriate treatment plans.

You should have an unrestricted RN license, 3+ years of RN experience, and 1+ year in Med/Surg, plus strong Microsoft Office skills. This is a full-time, remote position within the United States.

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

Clinical judgment

Collaboration

Attention to detail

Education

Associate degree in nursing

Tools

Microsoft Office (Outlook)

Microsoft Teams

Microsoft Excel

Job description

CVS Health is seeking a Remote RN Utilisation Management Nurse Consultant for Medicare joint procedures. The role focuses on evaluating clinical information, applying evidence-based criteria, and coordinating care with providers to ensure appropriate treatment plans.

You should have an unrestricted RN license, 3+ years of RN experience, and 1+ year in Med/Surg, plus strong Microsoft Office skills. This is a full-time, remote position within the United States.