Remote RN Utilisation Management—Medicare Joint Procedures

CVS Health; Maryland City (MD); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, vision

Paid time off

Wellness program

Job summary

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant to support Medicare joint procedures in a remote, full-time role. You will review clinical information, apply evidence-based criteria, and coordinate with providers to determine appropriate care plans.

The role requires active RN license in your state, 3+ years RN experience, 1+ year Med/Surg, and proficiency with Microsoft Office.

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 license

RN experience

Med/Surg experience

Microsoft Office

Education

Associate degree in nursing

Tools

Microsoft Office

Job description

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant to support Medicare joint procedures in a remote, full-time role. You will review clinical information, apply evidence-based criteria, and coordinate with providers to determine appropriate care plans.

The role requires active RN license in your state, 3+ years RN experience, 1+ year Med/Surg, and proficiency with Microsoft Office.