Remote RN Utilization Management & Precertification Consultant

CVS Health; Juneau (AK); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant in a full-time remote role. You will apply clinical judgment to determine coverage and coordinate care, collaborating with providers and internal teams to optimize member outcomes.

Requires ~3+ years as a Registered Nurse, active RN license, and experience with Med/Surg. Proficiency in Microsoft Office is expected; Medicare or UM experience is preferred.

Qualifications

• 3+ years of experience as a Registered Nurse.
• Active, current and unrestricted RN licensure in state of residence.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).

Responsibilities

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Skills

RN nursing

Med/Surg experience

Microsoft Office

Education

Associate degree

BSN

Tools

MedCompass

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant in a full-time remote role. You will apply clinical judgment to determine coverage and coordinate care, collaborating with providers and internal teams to optimize member outcomes.

Requires ~3+ years as a Registered Nurse, active RN license, and experience with Med/Surg. Proficiency in Microsoft Office is expected; Medicare or UM experience is preferred.