Remote RN Utilization & Precertification Consultant

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

Benefits offered by this job

Comprehensive benefits package

Remote work option

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for a remote full-time role with weekend coverage. You will review clinical information to support coverage determinations, apply guidelines, and collaborate with care teams to coordinate treatment plans.

The ideal candidate holds an active RN license, 3+ years RN experience, and 1+ year Med/Surg experience, with proficiency in Microsoft Office and a willingness to work the post-training schedule.

Qualifications

• Active, unrestricted RN license in the 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.

Responsibilities

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines and policies to the care continuum.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to enhance quality and member outcomes.
• Refer members to additional programs and services as appropriate.
• Serve as a clinical resource within utilization/benefit management.

Skills

RN experience

Microsoft Office

Clinical judgment

Care coordination

Education

RN license (unrestricted)

Tools

Microsoft Office 365

EHR systems

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for a remote full-time role with weekend coverage. You will review clinical information to support coverage determinations, apply guidelines, and collaborate with care teams to coordinate treatment plans.

The ideal candidate holds an active RN license, 3+ years RN experience, and 1+ year Med/Surg experience, with proficiency in Microsoft Office and a willingness to work the post-training schedule.