Remote RN Utilization Management Consultant (Medicare)

CVS Health; Central City (KY); 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 seeks an experienced RN for a remote Utilisation Management Nurse Consultant role focused on Medicare joint procedures. You will review cases, apply criteria, and coordinate care across teams to ensure appropriate treatment.

The position is full-time, remote, with a weekday schedule and occasional evenings. An active RN license, 3+ years RN experience, and 1+ year Med/Surg experience are required, along with proficiency in Microsoft Office.

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

Outlook

Teams

Excel

Job description

CVS Health seeks an experienced RN for a remote Utilisation Management Nurse Consultant role focused on Medicare joint procedures. You will review cases, apply criteria, and coordinate care across teams to ensure appropriate treatment.

The position is full-time, remote, with a weekday schedule and occasional evenings. An active RN license, 3+ years RN experience, and 1+ year Med/Surg experience are required, along with proficiency in Microsoft Office.