Remote Utilization Management Nurse Consultant (Medicare)

CVS Health; United States; À distance; USD 40 000 - 86 000; Plein temps

Avantages offerts par ce poste

Bonus eligibility

Comprehensive benefits

Paid time off

Résumé du poste

CVS Health is seeking an Utilization Management Nurse Consultant to support Medicare precertification from a remote location. The role focuses on reviewing cases, determining coverage using evidence-based criteria, and collaborating with care teams to plan treatment.

Strong clinical judgment and 3+ years of RN experience are required, with ADN preferred. Flexible, full-time remote schedule and 9:00–5:30 in local time zone.

Qualifications

• Active, unrestricted RN license in the state of residence.
• Minimum 3 years of RN experience.
• Strong clinical assessment, critical thinking and decision-making skills.
• Proficiency with Microsoft Office applications, including Outlook, Teams and Excel.
• Associate Degree in Nursing (ADN).

Responsabilités

• Review clinical cases and make coverage determinations using evidence-based criteria.
• Collaborate with providers and interdisciplinary care teams to support treatment planning.
• Apply clinical judgment to utilization management and prior authorization decisions.
• Identify opportunities to improve quality, outcomes and member experience.

Connaissances

RN license

Clinical assessment

Critical thinking

Decision-making

Communication

Formation

Associate Degree in Nursing (ADN)

Outils

Outlook

Excel

Teams

VPN access

Description du poste

CVS Health is seeking an Utilization Management Nurse Consultant to support Medicare precertification from a remote location. The role focuses on reviewing cases, determining coverage using evidence-based criteria, and collaborating with care teams to plan treatment.

Strong clinical judgment and 3+ years of RN experience are required, with ADN preferred. Flexible, full-time remote schedule and 9:00–5:30 in local time zone.