Remote Utilization Management Nurse Consultant (Medicare)

CVS Health; Arkansas City (KS); Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. This full-time, remote role will involve assessing and coordinating care, applying clinical criteria to determine coverage, and collaborating with providers to support appropriate services in members’ care plans.

The position requires 3+ years as an RN, active licensure, 1+ year Med/Surg, and proficiency with Microsoft Office. Prior authorization or utilization management experience is preferred.

Qualifications

• 3+ years of RN experience
• Active, unrestricted RN licensure in state of residence
• 1+ year of Med/Surg experience
• 1+ year of experience with Microsoft Office apps (Outlook, Teams, Excel)

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 and other parties to facilitate care/treatment
• Identify members for referral opportunities to integrate with other programs
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
• Consult and lend expertise to other internal and external constituents in utilization/benefit management

Skills

RN licensure

Med/Surg

Microsoft Office

Healthcare coordination

Education

Associates degree

BSN preferred

Tools

MedCompass

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. This full-time, remote role will involve assessing and coordinating care, applying clinical criteria to determine coverage, and collaborating with providers to support appropriate services in members’ care plans.

The position requires 3+ years as an RN, active licensure, 1+ year Med/Surg, and proficiency with Microsoft Office. Prior authorization or utilization management experience is preferred.