Remote RN Utilization Management Consultant (Medicare)

CVS Health; Athens (GA); Remote; USD 36,000 - 86,000; Full time

Job summary

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) to work remotely in a full-time role. You will apply clinical judgment to ensure appropriate care decisions and collaborate with providers to coordinate treatment plans.

Join a mission-driven team that emphasizes quality, compliance, and patient-focused outcomes while enabling a flexible weekday schedule and comprehensive benefits.

Qualifications

• Active, unrestricted RN licence 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

Tools

Microsoft Office 365 (Teams, Outlook, Excel)

Job description

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) to work remotely in a full-time role. You will apply clinical judgment to ensure appropriate care decisions and collaborate with providers to coordinate treatment plans.

Join a mission-driven team that emphasizes quality, compliance, and patient-focused outcomes while enabling a flexible weekday schedule and comprehensive benefits.