Remote RN Utilization Management Consultant (Medicare)

CVS Health; Elm (PA); À distance; USD 36 000 - 86 000; Plein temps

Résumé du poste

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. You will review clinical information, apply evidence-based criteria, and make coverage determinations while coordinating with providers and care teams.

This role emphasizes quality care and collaboration, supporting members to access the right services. Required: active RN license, 3+ years RN experience, 1+ year Med/Surg, and MS Office proficiency.

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.

Responsabilités

• 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.

Connaissances

RN licensure

RN experience

Med/Surg experience

Microsoft Office

Associates degree in nursing

Formation

Associate degree in nursing

Outils

Outlook

Teams

Excel

Description du poste

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. You will review clinical information, apply evidence-based criteria, and make coverage determinations while coordinating with providers and care teams.

This role emphasizes quality care and collaboration, supporting members to access the right services. Required: active RN license, 3+ years RN experience, 1+ year Med/Surg, and MS Office proficiency.