Remote RN Utilization Management Consultant – Medicare

CVS Health; Idaho; 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 join a remote, full-time team. You will review clinical information for precertification and coordinate care with providers to ensure appropriate treatment plans.

This role requires evidence-based decision making, collaboration with care teams, and a commitment to improving care quality. Strong MS Office skills and 3+ years RN experience are essential.

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).
• 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

Education

Associate degree in nursing

Tools

Microsoft Office

Job description

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) to join a remote, full-time team. You will review clinical information for precertification and coordinate care with providers to ensure appropriate treatment plans.

This role requires evidence-based decision making, collaboration with care teams, and a commitment to improving care quality. Strong MS Office skills and 3+ years RN experience are essential.