Remote RN Utilisation Management Consultant (Medicare)

CVS Health; Pennsylvania; À distance; USD 36 000 - 86 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Résumé du poste

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. You will review clinical data for precertification, apply evidence-based criteria, and coordinate care with providers to ensure appropriate treatment.

You bring an active RN license, 3+ years RN and 1+ year Med/Surg, plus proficiency in Microsoft Office. Nice-to-have: UM or Medicare experience and a BSN.

Qualifications

• Active, unrestricted RN license in your state of residence.
• Three or more years of RN experience.
• At least one year of Med/Surg experience.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).
• Associate degree in nursing.

Responsabilités

• 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.

Connaissances

RN license

RN experience

Med/Surg experience

MS Office

Office proficiency

Formation

Associate degree in nursing

Outils

Outlook

Teams

Excel

Description du poste

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. You will review clinical data for precertification, apply evidence-based criteria, and coordinate care with providers to ensure appropriate treatment.

You bring an active RN license, 3+ years RN and 1+ year Med/Surg, plus proficiency in Microsoft Office. Nice-to-have: UM or Medicare experience and a BSN.