Remote RN Utilization Management Nurse Consultant (Medicare)

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

Job summary

CVS Health is seeking an RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. You will review clinical data, apply criteria, and coordinate plans to ensure members receive appropriate care in a timely manner.

Ideal candidates have an active RN license in their state, 3+ years of RN experience, and 1+ year Med/Surg experience, plus strong MS Office skills. ABS in nursing is required and priorUtilisation Management experience is a plus.

Qualifications

• Active, unrestricted RN licence in 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

RN experience

Med/Surg experience

MS Office proficiency

Associate degree in nursing

Education

Associate degree in nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking an RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. You will review clinical data, apply criteria, and coordinate plans to ensure members receive appropriate care in a timely manner.

Ideal candidates have an active RN license in their state, 3+ years of RN experience, and 1+ year Med/Surg experience, plus strong MS Office skills. ABS in nursing is required and priorUtilisation Management experience is a plus.