Remote Utilization Management Nurse Consultant

4004 Aetna Medicaid Administrators; Virginia (MN); Hybrid; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement options

Job summary

CVS Health is seeking a remote Precertification Nurse to review clinical information and authorize procedures from providers. The role is telework everywhere with a preference for Virginia residents or those with Virginia licensure.

You will collect data by phone, apply evidence-based criteria, and initiate Medical Director referrals as needed. Candidates must hold an active RN license with at least an Associate’s degree and 3+ years of nursing experience.

Qualifications

• Active, current RN license in resident state with an Associate’s Degree.
• 3+ years of clinical nursing experience.
• Ability to work 8am-5pm with occasional on-call weekends/holidays.

Responsibilities

• Conduct precertification reviews using clinical criteria.
• Review medical information from providers and authorize procedures/services.
• Initiate Medical Director referrals as needed.
• Work from home with a dedicated home office setup.

Skills

RN licensure

Clinical nursing

Flexible schedule

Computer skills

Education

Associate degree

BSN preferred

Tools

EHR systems

Microsoft Office 365

Job description

CVS Health is seeking a remote Precertification Nurse to review clinical information and authorize procedures from providers. The role is telework everywhere with a preference for Virginia residents or those with Virginia licensure.

You will collect data by phone, apply evidence-based criteria, and initiate Medical Director referrals as needed. Candidates must hold an active RN license with at least an Associate’s degree and 3+ years of nursing experience.