Remote RN Utilization Management Consultant

CVS Health; San Francisco (CA); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant. The role requires nursing expertise to assess and coordinate healthcare services, with an emphasis on Medicare precertification and utilization management.

The position supports a 9:00–17:30 schedule in the candidate's time zone and involves collaboration with providers to ensure appropriate care and benefits. A BSN is preferred and a valid RN license is required.

Qualifications

• 3+ years of nursing experience as an RN.
• Active, unrestricted RN licensure in state of residence.
• 1+ year of Med/Surg experience.
• 1+ year 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 the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determinations.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other products, services and/or programs.
• Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Skills

RN experience

RN licensure

Med/Surg experience

Education

Associates degree

BSN

Tools

Microsoft Office

Job description

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant. The role requires nursing expertise to assess and coordinate healthcare services, with an emphasis on Medicare precertification and utilization management.

The position supports a 9:00–17:30 schedule in the candidate's time zone and involves collaboration with providers to ensure appropriate care and benefits. A BSN is preferred and a valid RN license is required.