Remote RN Utilization Management Consultant (Medicare)

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

Job summary

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant to impact care beyond the bedside. This remote, full-time role supports Medicare joint procedures by reviewing clinical information and applying criteria to determine coverage.

You will collaborate with providers and care teams to coordinate treatment plans, identify opportunities to improve quality and utilisation, and serve as a clinical resource for internal and external partners. Monday–Friday schedule.

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 licensure

Clinical assessment

Care coordination

Team collaboration

Education

Associate degree in nursing

Tools

Microsoft Office

Job description

CVS Health is seeking an experienced RN Utilisation Management Nurse Consultant to impact care beyond the bedside. This remote, full-time role supports Medicare joint procedures by reviewing clinical information and applying criteria to determine coverage.

You will collaborate with providers and care teams to coordinate treatment plans, identify opportunities to improve quality and utilisation, and serve as a clinical resource for internal and external partners. Monday–Friday schedule.