Remote RN Utilization Management Consultant – Medicare

CVS Health; Yorktown (VA); Remote; USD 36.000 - 86.000; Vollzeit

Zusammenfassung

CVS Health is recruiting an RN Utilisation Management Nurse Consultant for Medicare joint procedures. This remote, full-time role follows a Monday–Friday schedule with some evenings/holidays and focuses on ensuring members receive the right care at the right time.

You will review patient data, apply criteria, and coordinate with care teams. A clinical resource and a mission-driven team await your expertise.

Qualifikationen

• Active, unrestricted RN license 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.

Aufgaben

• 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.

Kenntnisse

Active RN license

RN experience

Med/Surg experience

MS Office (Outlook/Teams/Excel)

Ausbildung

Associate degree in nursing

Tools

Microsoft Office

Jobbeschreibung

CVS Health is recruiting an RN Utilisation Management Nurse Consultant for Medicare joint procedures. This remote, full-time role follows a Monday–Friday schedule with some evenings/holidays and focuses on ensuring members receive the right care at the right time.

You will review patient data, apply criteria, and coordinate with care teams. A clinical resource and a mission-driven team await your expertise.