Remote RN Utilization Management Consultant

CVS Health; Atlanta (GA); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess and coordinate healthcare services for members. The role emphasizes clinical judgment, collaboration with providers, and effective utilization management.

Strong RN background and licensure are required, with Med/Surg and Office suite experience helping drive decisions. Work from home within the United States is required, with a 40-hour workweek and a schedule that includes holidays and evenings.

Qualifications

• 3+ years of experience as a Registered Nurse
• Active, current RN licensure in state of residence
• 1+ years of Med/Surg experience
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)
• BSN preferred
• Associates degree required

Responsibilities

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Skills

RN experience

Microsoft Office

Education

Associates degree

BSN preferred

Tools

MedCompass

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess and coordinate healthcare services for members. The role emphasizes clinical judgment, collaboration with providers, and effective utilization management.

Strong RN background and licensure are required, with Med/Surg and Office suite experience helping drive decisions. Work from home within the United States is required, with a 40-hour workweek and a schedule that includes holidays and evenings.