Remote RN Utilization Management Consultant (Medicare)

CVS Health; Guin (AL); À distance; USD 36 000 - 86 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Retirement savings options

Paid time off

Résumé du poste

CVS Health is seeking an experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on Medicare joint procedures. You will review clinical information for precertification, apply criteria, and collaborate with providers to coordinate treatment plans, ensuring appropriate care and utilization.

The position requires 3+ years RN experience, an active RN license, an associate degree in nursing, and proficiency with MS Office.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years of RN experience.
• 1+ year of Med/Surg experience.
• Proficiency in Microsoft Office (Outlook, Teams, Excel).

Responsabilités

• Review and assess clinical information for Medicare precertification (joint procedures)
• Apply evidence-based criteria to make coverage determinations
• Collaborate with providers and care teams to coordinate treatment plans
• Identify opportunities to improve care quality and optimize utilization
• Support care integration by connecting members to programs and services
• Serve as a clinical resource to internal and external partners

Connaissances

RN license

RN experience

Med/Surg experience

Microsoft Office

Formation

Associates degree in nursing

Description du poste

CVS Health is seeking an experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on Medicare joint procedures. You will review clinical information for precertification, apply criteria, and collaborate with providers to coordinate treatment plans, ensuring appropriate care and utilization.

The position requires 3+ years RN experience, an active RN license, an associate degree in nursing, and proficiency with MS Office.