Remote RN Utilization Manager – Medicare Joint Procedures

CVS Health; Beryl (WV); Remote; USD 36,000 - 86,000; Full time

Job summary

CVS Health is seeking an experienced Registered Nurse to join the Utilization Management team in a remote, full-time role focused on Medicare joint procedures. You will review clinical information, apply criteria, and coordinate care plans to ensure members receive appropriate services.

Ideal candidates have an active RN license in their state, 3+ years of RN experience, and strong proficiency with Microsoft Office. Prior Med/Surg exposure and knowledge of managed care are a plus.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years of RN experience.
• 1+ year of Med/Surg experience.
• Proficiency in Microsoft Office (Outlook, Teams, Excel).
• Associates degree in nursing.

Responsibilities

• Review and assess clinical information for Medicare precertification (joint procedures).
• Apply evidence-based criteria and clinical judgment to make coverage determinations.
• Collaborate with providers and care teams to coordinate appropriate treatment plans.
• Identify opportunities to improve care quality and optimize healthcare utilization.
• Support care integration by connecting members to additional programs and services.
• Serve as a clinical resource to internal and external partners.

Skills

RN experience

Microsoft Office

Communication skills

Education

Associates degree in nursing

Tools

Outlook

Teams

Excel

Word

PowerPoint

Job description

CVS Health is seeking an experienced Registered Nurse to join the Utilization Management team in a remote, full-time role focused on Medicare joint procedures. You will review clinical information, apply criteria, and coordinate care plans to ensure members receive appropriate services.

Ideal candidates have an active RN license in their state, 3+ years of RN experience, and strong proficiency with Microsoft Office. Prior Med/Surg exposure and knowledge of managed care are a plus.