Remote RN Utilization Management Consultant – Medicare

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

Job summary

CVS Health in the United States is seeking an experienced RN to join the Medicare Utilisation Management team in a remote, full-time role. You will leverage clinical judgment to ensure appropriate care through precertification reviews for joint procedures.

This position emphasizes collaboration with providers, adherence to evidence-based criteria, and opportunities to impact care quality while working from home in your time zone.

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 license

RN experience

Med/Surg experience

Microsoft Office

Education

Associate degree in nursing

Tools

Microsoft Office 365

Job description

CVS Health in the United States is seeking an experienced RN to join the Medicare Utilisation Management team in a remote, full-time role. You will leverage clinical judgment to ensure appropriate care through precertification reviews for joint procedures.

This position emphasizes collaboration with providers, adherence to evidence-based criteria, and opportunities to impact care quality while working from home in your time zone.