Remote RN Utilisation Management Nurse (Medicare)

CVS Health; Connecticut; À distance; USD 36 000 - 85 000; Plein temps

Avantages offerts par ce poste

Medical benefits

Dental benefits

Vision benefits

PTO

Retirement plan

Wellness programs

Résumé du poste

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant to support Medicare joint procedures. This remote, full-time role focuses on ensuring appropriate care, coordinating plans, and applying evidence-based criteria for coverage decisions.

You’ll collaborate with care teams, leverage MS Office, and bring 3+ years of RN experience plus a nursing degree to a mission-driven, patient-centered Utilisation Management team.

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.

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 exp

MS Office

Formation

Associate degree in nursing

Outils

MedCompass

Description du poste

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant to support Medicare joint procedures. This remote, full-time role focuses on ensuring appropriate care, coordinating plans, and applying evidence-based criteria for coverage decisions.

You’ll collaborate with care teams, leverage MS Office, and bring 3+ years of RN experience plus a nursing degree to a mission-driven, patient-centered Utilisation Management team.