Remote RN Utilization Management Consultant

CVS Health; Austin (TX); Remote; USD 36,000 - 95,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Equipment provided

Job summary

CVS Health is seeking an experienced Medicare Precertification Utilization Management Nurse Consultant to join a 24/7 operation in a role requiring RN licensure and clinical collaboration. The position involves assessing care plans, applying clinical guidelines, communicating with providers, and referring opportunities to integrate with other CVS Health programs.

Required are ~3+ years as an RN, active licensure, MS/Med/Surg experience, and proficiency with Microsoft Office.

Qualifications

• ~3+ years of experience as a Registered Nurse.
• ~Must have active current and unrestricted RN licensure in state of residence.
• ~1+ years of Med/Surg experience.
• ~1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).

Responsibilities

• Utilizes clinical experience to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies criteria/guidelines to render coverage determination/recommendation.
• 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 licensure

Clinical experience

Med/Surg experience

Education

Associate degree

BSN preferred

Tools

Microsoft Office 365

MedCompass

Job description

CVS Health is seeking an experienced Medicare Precertification Utilization Management Nurse Consultant to join a 24/7 operation in a role requiring RN licensure and clinical collaboration. The position involves assessing care plans, applying clinical guidelines, communicating with providers, and referring opportunities to integrate with other CVS Health programs.

Required are ~3+ years as an RN, active licensure, MS/Med/Surg experience, and proficiency with Microsoft Office.