Remote RN Utilization Consultant Medicare Joint Procedures

CVS Health; Georgia; Remoto; USD 36.000 - 86.000; Tempo pieno

Descrizione del lavoro

CVS Health is seeking an experienced RN for an Utilisation Management Nurse Consultant role focusing on Medicare joint procedures. This remote, full-time position supports evidence-based decisions to ensure appropriate care.

You’ll collaborate with care teams, coordinate plans, and act as a clinical resource for internal and external partners. The role requires an active RN license in the resident state, 3+ years RN experience, 1+ year Med/Surg, and strong MS Office skills.

Competenze

• 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).

Mansioni

• 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.

Conoscenze

RN experience

Microsoft Office

Formazione

Associate degree in nursing

Strumenti

Microsoft Office 365

Descrizione del lavoro

CVS Health is seeking an experienced RN for an Utilisation Management Nurse Consultant role focusing on Medicare joint procedures. This remote, full-time position supports evidence-based decisions to ensure appropriate care.

You’ll collaborate with care teams, coordinate plans, and act as a clinical resource for internal and external partners. The role requires an active RN license in the resident state, 3+ years RN experience, 1+ year Med/Surg, and strong MS Office skills.