Remote RN Utilization Management Consultant

CVS Health; Hydaburg (AK); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programmes

Job summary

CVS Health in the United States seeks an RN Utilisation Management Nurse Consultant to support Medicare joint procedures in a remote, full-time role. Remote work with some evenings/holidays as required; strong collaboration with cross-functional teams.

You will review clinical data for precertifications, apply evidence-based criteria, coordinate care with providers, and help optimise utilization while upholding safety and quality.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years of RN experience.
• 1+ year of Med/Surg experience.
• Proficiency in Microsoft Office (Outlook, Teams, Excel).
• Associate degree in nursing.

Responsibilities

• Review and assess clinical information for Medicare precertification (joint procedures).
• Apply evidence-based criteria and clinical judgement to make coverage determinations.
• Collaborate with providers and care teams to coordinate appropriate treatment plans.
• Identify opportunities to improve care quality and optimise healthcare utilisation.
• Support care integration by connecting members to additional programmes and services.
• Serve as a clinical resource to internal and external partners.

Skills

RN license

RN experience

Med/Surg experience

Microsoft Office

Education

Associate degree in nursing

Job description

CVS Health in the United States seeks an RN Utilisation Management Nurse Consultant to support Medicare joint procedures in a remote, full-time role. Remote work with some evenings/holidays as required; strong collaboration with cross-functional teams.

You will review clinical data for precertifications, apply evidence-based criteria, coordinate care with providers, and help optimise utilization while upholding safety and quality.