Remote RN Utilization Consultant-Medicare Joint Procedures

CVS Health; Virginia; Remote; USD 36,000 - 85,000; Full time

Job summary

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role with a Monday–Friday schedule. You will review Medicare precertifications, apply evidence-based criteria, and coordinate treatment plans to ensure appropriate care while collaborating with care teams and providers.

The position requires an active RN license in the state of residence, 3+ years of RN experience, 1+ year in Med/Surg, and proficiency with

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).

Responsibilities

• 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.

Skills

RN experience

Med/Surg experience

RN licensure

Clinical decision making

Education

Associate degree in nursing

Tools

Microsoft Office

Job description

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role with a Monday–Friday schedule. You will review Medicare precertifications, apply evidence-based criteria, and coordinate treatment plans to ensure appropriate care while collaborating with care teams and providers.

The position requires an active RN license in the state of residence, 3+ years of RN experience, 1+ year in Med/Surg, and proficiency with