Remote RN Utilization Management Nurse Consultant

CVS Health; Sioux Falls (SD); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role focuses on using clinical judgment to determine appropriate services and benefits, coordinating with providers and teams to support member care while adhering to policies and HIPAA guidelines.

Candidates should have RN licensure and 3+ years of experience, with Med/Surg exposure and proficiency in MS Office. This full-time remote-capable role requires a quiet home workspace and availability for

Qualifications

• Active RN licensure in state of residence
• 3+ years of RN experience
• 1+ years of Med/Surg experience
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services/benefits for members
• Apply clinical criteria/guidelines to determine coverage decisions/recommendations
• Communicate with providers and other parties to facilitate care/treatment
• Identify referral opportunities to integrate with other products/services
• Consult and lend clinical expertise to internal/external partners in care management

Skills

Registered Nurse

Clinical assessment

Provider communication

Education

Associate degree

BSN preferred

Tools

Microsoft Office 365

Outlook

Excel

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role focuses on using clinical judgment to determine appropriate services and benefits, coordinating with providers and teams to support member care while adhering to policies and HIPAA guidelines.

Candidates should have RN licensure and 3+ years of experience, with Med/Surg exposure and proficiency in MS Office. This full-time remote-capable role requires a quiet home workspace and availability for