Remote RN Utilization & Care Coordination Consultant

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

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join our remote team on weekends after training. You will review clinical information to support coverage determinations and collaborate with providers to coordinate care, ensuring members receive appropriate care.

Active RN license in state of residence, 3+ years of RN experience including Med/Surg, and proficiency with Microsoft Office are required.

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).
• Willingness to work the required schedule post-training.

Responsibilities

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines, policies, and sound judgment across the care continuum.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to enhance quality, efficiency, and member outcomes.
• Refer members to additional programs and services as appropriate.
• Serve as a clinical resource within utilization/benefit management.

Skills

RN license

RN experience

Med/Surg experience

Microsoft Office

Education

BSN preferred

Associate’s degree required

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join our remote team on weekends after training. You will review clinical information to support coverage determinations and collaborate with providers to coordinate care, ensuring members receive appropriate care.

Active RN license in state of residence, 3+ years of RN experience including Med/Surg, and proficiency with Microsoft Office are required.