Remote RN Utilization & Quality Management Consultant

CVS Health; Lansing (MI); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role requires 3+ years of RN experience, active RN licensure, and strong Med/Surg and Office software skills.

You will assess care needs, apply clinical criteria, and coordinate with providers to determine appropriate care and benefits. This full-time remote position supports a 24/7 Utilization Management operation, with holiday and evening hours, and requires a quiet home workspace compliant with

Qualifications

• Active, current RN licensure in state of residence.
• 3+ years of RN Experience.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).
• Associates degree required; BSN preferred.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits.
• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care and treatment.
• Identify members for referral opportunities to integrate with programs.
• 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

Med/Surg experience

Microsoft Office proficiency

Education

Associates degree

BSN preferred

Tools

Microsoft Office 365

EHR portal

MedCompass

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role requires 3+ years of RN experience, active RN licensure, and strong Med/Surg and Office software skills.

You will assess care needs, apply clinical criteria, and coordinate with providers to determine appropriate care and benefits. This full-time remote position supports a 24/7 Utilization Management operation, with holiday and evening hours, and requires a quiet home workspace compliant with