Remote RN Utilization Management Consultant – Medicare

CVS Health; Bastrop (LA); 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 is seeking an experienced RN for Utilisation Management focusing on Medicare joint procedures. This remote, full-time role supports ensuring members receive the right care at the right time, collaborating with providers and care teams to coordinate effective treatment plans.

You bring an active RN licence, 3+ years of RN experience, 1+ year in Med/Surg, and proficiency with MS Office. This position offers strong benefits and a patient-centered mission.

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

MS Office

Education

Associate degree in nursing

Tools

MedCompass

Job description

CVS Health is seeking an experienced RN for Utilisation Management focusing on Medicare joint procedures. This remote, full-time role supports ensuring members receive the right care at the right time, collaborating with providers and care teams to coordinate effective treatment plans.

You bring an active RN licence, 3+ years of RN experience, 1+ year in Med/Surg, and proficiency with MS Office. This position offers strong benefits and a patient-centered mission.