Remote RN Utilization & Quality Management Consultant

CVS Health; Missouri; Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Healthcare benefits

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role involves applying clinical judgement to determine appropriate care and benefits, coordinating with providers, and supporting utilization management across a 24/7 schedule with some holidays and evenings.

Associates degree is required with BSN preferred, and RN licensure must be active in the home state. Strong MS Office and MedCompass experience is valued; remote work is available to qualified

Qualifications

• 3+ years of experience as a Registered Nurse.
• Must have active current and unrestricted RN licensure in state of residence.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate care options for members.
• Render coverage determinations with clinical criteria and guidelines.
• Communicate with providers and other stakeholders to facilitate care.
• Identify referral opportunities and promote quality utilization of healthcare services.
• Consult internal and external constituents in utilization/benefit management.

Skills

RN experience

RN licensure

Med/Surg

MS Office

Education

Associates degree

BSN preferred

Tools

MedCompass

Microsoft Office 365

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role involves applying clinical judgement to determine appropriate care and benefits, coordinating with providers, and supporting utilization management across a 24/7 schedule with some holidays and evenings.

Associates degree is required with BSN preferred, and RN licensure must be active in the home state. Strong MS Office and MedCompass experience is valued; remote work is available to qualified