Remote RN Utilization Management Nurse

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

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Wellness programs

Other resources

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join the remote Utilization Management team. This full-time role operates on a 4-day weekend schedule after training, with evenings and holidays possible in a 24/7 operation.

The RN will assess clinical information for coverage determinations and coordinate care with providers. Requires active RN license, 3+ years RN and 1+ year Med/Surg experience, and proficiency with Microsoft Office.

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).
• Willingness to work required schedule post-training.

Responsibilities

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines, policies, and sound judgment across the care continuum.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to enhance quality, efficiency, and member outcomes.
• Refer members to additional programs and services as appropriate.
• Serve as a clinical resource within utilization/benefit management.

Skills

RN license

RN experience

Med/Surg experience

Microsoft Office

Schedule flexibility

Education

ADN/BSN acceptable

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join the remote Utilization Management team. This full-time role operates on a 4-day weekend schedule after training, with evenings and holidays possible in a 24/7 operation.

The RN will assess clinical information for coverage determinations and coordinate care with providers. Requires active RN license, 3+ years RN and 1+ year Med/Surg experience, and proficiency with Microsoft Office.