Remote RN Utilization & Precertification Consultant

CVS Health; Helena (MT); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking an experienced Medicare Precertification Utilization Management Nurse Consultant. The role requires an RN with ~3+ years of clinical experience and active licensure in the state of residence.

You will coordinate care, apply clinical criteria, and communicate with providers to support appropriate benefits and services. Work-from-Home based position with standard 9:00am–5:30pm hours in the candidate's time zone, plus holiday/evening shifts as needed.

Qualifications

• 3+ years of RN experience.
• Active RN licensure in state of residence.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply criteria to render coverage determinations/recommendations.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other products/services.
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to internal and external constituents in utilization/benefit management.

Skills

Registered Nurse experience

Med/Surg experience

Prior Authorization

Managed care

Ambulatory surgery experience

Medicare experience

Education

Associate degree

BSN preferred

Tools

Microsoft Office

MedCompass

Job description

CVS Health is seeking an experienced Medicare Precertification Utilization Management Nurse Consultant. The role requires an RN with ~3+ years of clinical experience and active licensure in the state of residence.

You will coordinate care, apply clinical criteria, and communicate with providers to support appropriate benefits and services. Work-from-Home based position with standard 9:00am–5:30pm hours in the candidate's time zone, plus holiday/evening shifts as needed.