Remote RN Utilization Management Consultant

CVS Health; Clayton (MO); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to apply clinical judgment in determining coverage and coordinating patient care. The role supports a 9:00 am–5:30 pm schedule in the candidate's time zone and includes holiday/evening hours due to the 24/7 utilization management operation.

The position requires 3+ years of RN experience, an active RN license, and 1+ year in Med/Surg, with proficiency in Microsoft Office.

Qualifications

• Must have 3+ years of RN experience.
• Active, current RN license in state of residence.
• 1+ year of Med/Surg experience required.
• 1+ year of experience with Microsoft Office (Outlook, Teams, Excel).

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate healthcare services/benefits.
• Render coverage determinations/recommendations using clinical criteria and judgment.
• Communicate with providers to facilitate care and treatment.
• Identify referral opportunities to integrate with other products and programs.
• Contribute to quality and effectiveness of healthcare services and benefit utilization.

Skills

RN experience

Active RN license

Med/Surg experience

Microsoft Office

Education

Associates degree required

BSN preferred

Tools

MedCompass

Ambulatory surgery

Medicare experience

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to apply clinical judgment in determining coverage and coordinating patient care. The role supports a 9:00 am–5:30 pm schedule in the candidate's time zone and includes holiday/evening hours due to the 24/7 utilization management operation.

The position requires 3+ years of RN experience, an active RN license, and 1+ year in Med/Surg, with proficiency in Microsoft Office.