Remote RN Utilization Management Consultant

CVS Health; Portland (ME); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking an experienced RN Utilization Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time position. Expect a Monday–Friday schedule (9:00 am–5:30 pm in your time zone) with occasional evenings/holidays, focusing on ensuring appropriate care through precertification and evidence-based criteria.

The ideal candidate will have an active RN license, 3+ years of RN experience, Med/Surg exposure, and proficiency with Microsoft Office.

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).
• Associates degree in nursing.

Responsibilities

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

Skills

Active RN license

RN experience

Med/Surg experience

MS Office proficiency

Education

Associates degree in nursing

Tools

MedCompass

EHR systems

Job description

CVS Health is seeking an experienced RN Utilization Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time position. Expect a Monday–Friday schedule (9:00 am–5:30 pm in your time zone) with occasional evenings/holidays, focusing on ensuring appropriate care through precertification and evidence-based criteria.

The ideal candidate will have an active RN license, 3+ years of RN experience, Med/Surg exposure, and proficiency with Microsoft Office.