Remote RN Utilization Management Consultant

CVS Health; Baton Rouge (LA); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus program

Job summary

CVS Health is recruiting a Medicare Precertification Utilization Management Nurse Consultant in a remote-capable role. The position requires collaboration to assess, plan, implement, and monitor care, using clinical criteria to determine coverage and coordinate with providers.

The candidate will engage with members, identify referral opportunities, and promote high-quality, cost-effective healthcare services. A BSN is preferred and HIPAA-compliant remote work is supported.

Qualifications

• 3+ years of experience as a Registered Nurse.
• 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

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply clinical criteria to render coverage determinations/recommendations.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other products or programs.
• Consult with internal and external stakeholders in utilization/benefit management.

Skills

Registered Nurse

Med/Surg

Microsoft Office

Education

Associate degree

BSN preferred

Tools

MedCompass

Job description

CVS Health is recruiting a Medicare Precertification Utilization Management Nurse Consultant in a remote-capable role. The position requires collaboration to assess, plan, implement, and monitor care, using clinical criteria to determine coverage and coordinate with providers.

The candidate will engage with members, identify referral opportunities, and promote high-quality, cost-effective healthcare services. A BSN is preferred and HIPAA-compliant remote work is supported.