Remote RN - Utilization Management Consultant

CVS Health; Seattle (WA); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to join our team in a remote capacity. Schedule is Monday through Friday, 9:00am to 5:30pm in the candidate's time zone, with 24/7 utilization management coverage including holidays and evenings.

The role utilizes clinical nursing experience to assess, plan, coordinate care, render coverage determinations, communicate with providers, and identify referral opportunities.

Qualifications

• 3+ years of RN experience and active RN licensure in the resident state.
• At least 1 year in Med/Surg nursing.
• Proficiency with Microsoft Office applications (Outlook, Teams, Excel).

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate care options.
• Render coverage determinations and recommendations along the care continuum.
• Communicate with providers to facilitate care and treatment.
• Identify referral opportunities to integrate with other programs.
• Promote quality and appropriate utilization of healthcare services.
• Consult with internal and external stakeholders on utilization management.

Skills

RN licensure

Med/Surg experience

MS Office

Communication skills

Education

Associates degree

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to join our team in a remote capacity. Schedule is Monday through Friday, 9:00am to 5:30pm in the candidate's time zone, with 24/7 utilization management coverage including holidays and evenings.

The role utilizes clinical nursing experience to assess, plan, coordinate care, render coverage determinations, communicate with providers, and identify referral opportunities.