Remote RN Utilization Management Consultant (Medicare)

CVS Health; Kentucky; Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a seasoned RN in a remote, full-time role as Utilisation Management Nurse Consultant for Medicare joint procedures. You will assess clinical information, apply criteria, and coordinate treatment plans across care teams.

Ideal candidates hold an active RN license, 3+ years of RN experience including 1+ year Med/Surg, and proficiency with Microsoft Office. This non-bedside role offers weekday hours with potential evenings/holidays and a comprehensive benefits package.

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 Experience

Microsoft Office Proficiency

Education

Associate degree in nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking a seasoned RN in a remote, full-time role as Utilisation Management Nurse Consultant for Medicare joint procedures. You will assess clinical information, apply criteria, and coordinate treatment plans across care teams.

Ideal candidates hold an active RN license, 3+ years of RN experience including 1+ year Med/Surg, and proficiency with Microsoft Office. This non-bedside role offers weekday hours with potential evenings/holidays and a comprehensive benefits package.