Remote RN Utilization Management Specialist (Weekend)

CVS Health; Minneota (MN); Remoto; USD 36.000 - 86.000; Tempo pieno

Descrizione del lavoro

CVS Health is seeking an experienced Medicare Precertification Utilization Management Nurse Consultant (RN) to join our remote team. You will review clinical information to determine coverage, apply guidelines, and coordinate care with providers to ensure appropriate treatment plans.

The role requires an active RN license, 3+ years of RN experience (including Med/Surg), and proficiency with Microsoft Office.

Competenze

• 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.

Mansioni

• 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.

Conoscenze

RN license (active)

3+ years RN experience

Med/Surg experience

Microsoft Office

Formazione

ASN required

BSN preferred

Descrizione del lavoro

CVS Health is seeking an experienced Medicare Precertification Utilization Management Nurse Consultant (RN) to join our remote team. You will review clinical information to determine coverage, apply guidelines, and coordinate care with providers to ensure appropriate treatment plans.

The role requires an active RN license, 3+ years of RN experience (including Med/Surg), and proficiency with Microsoft Office.