Remote RN Utilization Management Consultant – Medicare

CVS Health; Iowa Center (IA); Remote; USD 36,000 - 85,000; Full time

Job summary

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant for Medicare joint procedures. This is a remote, full-time role with a standard 9-to-5-like schedule in your time zone and some evenings/holidays as needed.

In this role you will review clinical data for precertifications, apply criteria, coordinate treatment plans with providers, and identify opportunities to improve care quality and utilisation.

Qualifications

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

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

MS Office

Education

Associate degree in nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant for Medicare joint procedures. This is a remote, full-time role with a standard 9-to-5-like schedule in your time zone and some evenings/holidays as needed.

In this role you will review clinical data for precertifications, apply criteria, coordinate treatment plans with providers, and identify opportunities to improve care quality and utilisation.