Remote RN: Utilization Management Advisor

4062 Aetna Resources, LLC; Town of Florida (NY); Hybride; USD 61 000 - 130 000; Plein temps

Résumé du poste

CVS Health is seeking a Utilization Management Nurse Consultant for Clinical Precertification in Medicare Home Care, offering a remote, full-time weekday schedule. The role focuses on evidence-based coverage determinations, coordinating transitions from hospital to home care, and applying clinical judgment in utilization decisions.

The ideal candidate holds an active RN license, 2+ years of RN experience including Med/Surg, and proficient Microsoft Office skills.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 2+ 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 in your time zone.
• Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours.
• Associate Degree in Nursing.

Responsabilités

• Review clinical cases and make coverage determinations using evidence-based guidelines.
• Collaborate with home care providers, attending MDs and care teams to coordinate a smooth transition of care from a hospital and/or post-acute setting to home care.
• 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.

Connaissances

RN license

Clinical assessment

Decision making

Microsoft Office

Formation

Associate Degree in Nursing

Outils

Outlook

Teams

Excel

Description du poste

CVS Health is seeking a Utilization Management Nurse Consultant for Clinical Precertification in Medicare Home Care, offering a remote, full-time weekday schedule. The role focuses on evidence-based coverage determinations, coordinating transitions from hospital to home care, and applying clinical judgment in utilization decisions.

The ideal candidate holds an active RN license, 2+ years of RN experience including Med/Surg, and proficient Microsoft Office skills.