Remote RN Utilization Management Consultant – Medicare

CVS Health; Louisiana; Remoto; USD 36.000 - 86.000; Tempo pieno

Descrizione del lavoro

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) to work remotely. In this role you will review clinical information for precertification, apply criteria to determine coverage, and coordinate care plans with providers and care teams.

A collaborative, mission-driven environment supports quality care and ongoing professional growth. Ideal candidates hold an active RN license, at least 3 years of RN experience with 1+ year in Med/Surg,

Competenze

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

Mansioni

• Review and assess clinical information for Medicare precertification (joint procedures).
• Apply evidence-based criteria and clinical judgment 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.

Conoscenze

RN license

RN experience

Med/Surg experience

Microsoft Office

Formazione

Associate degree in nursing

Strumenti

Microsoft Office

Descrizione del lavoro

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) to work remotely. In this role you will review clinical information for precertification, apply criteria to determine coverage, and coordinate care plans with providers and care teams.

A collaborative, mission-driven environment supports quality care and ongoing professional growth. Ideal candidates hold an active RN license, at least 3 years of RN experience with 1+ year in Med/Surg,