Remote RN Utilization Consultant (Medicare)

CVS Health

Hydaburg (AK)

Remoto

USD 36.000 - 86.000

Tempo pieno

5 giorni fa

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Descrizione del lavoro

CVS Health is seeking a licensed RN to join our Utilization Management team in a remote, full-time role focused on Medicare precertification. You will review cases, determine coverage, and collaborate with providers to ensure appropriate care.

The role requires 3+ years of RN experience including Med/Surg, strong clinical judgment, and proficiency with Microsoft Office. You will work Monday–Friday 9:00 AM–6:00 PM in your time zone, with a 24/7 operation and holiday/evening coverage.

Competenze

Active, unrestricted RN license in the state of residence.
3+ years of RN experience, including 1+ year in Med/Surg
Strong clinical assessment and decision-making skills
Experience with Microsoft Office (Outlook, Teams, Excel)
Ability to work Monday-Friday, 9:00 AM-6:00 pm PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
Associate Degree in Nursing

Mansioni

Review clinical cases and make coverage determinations using evidence-based guidelines
Collaborate with providers and care teams to coordinate appropriate treatment
Apply clinical judgment to support utilization and benefit management decisions
Identify opportunities to improve care quality and member outcomes
Serve as a clinical resource across internal and external stakeholders