Remote RN Utilization Consultant – Medicare

CVS Health; Manchester (NH); À distance; USD 36 000 - 86 000; Plein temps

Résumé du poste

CVS Health is seeking an experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on Medicare joint procedures. You will review clinical information, apply criteria, and coordinate care with providers to ensure appropriate, timely treatment for members.

The role requires an active RN license in your state, 3+ years RN experience, 1+ year Med/Surg, and strong MS Office skills.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years of RN experience.
• 1+ year of Med/Surg experience.
• Proficiency in Microsoft Office (Outlook, Teams, Excel).
• Associates degree in nursing.

Responsabilités

• Review and assess clinical information for Medicare precertification (joint procedures).
• Apply evidence-based criteria and clinical judgment to make coverage determinations.
• Collaborate with providers and care teams to coordinate appropriate treatment plans.
• Identify opportunities to improve care quality and optimize healthcare utilization.
• Support care integration by connecting members to additional programs and services.
• Serve as a clinical resource to internal and external partners.

Connaissances

RN experience

Med/Surg experience

Formation

Associate degree in nursing

Outils

Microsoft Office

Outlook

Teams

Excel

Description du poste

CVS Health is seeking an experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on Medicare joint procedures. You will review clinical information, apply criteria, and coordinate care with providers to ensure appropriate, timely treatment for members.

The role requires an active RN license in your state, 3+ years RN experience, 1+ year Med/Surg, and strong MS Office skills.