Remote Utilization Management Nurse (RN) – Weekend Schedule

CVS Health; Minnesota; Remote; USD 36.000 - 86.000; Vollzeit

Benefits dieser Stelle

medical

dental

vision coverage

paid time off

retirement savings options

wellness programs

other resources

Zusammenfassung

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations and care coordination from a remote, full-time role with weekend shifts. The successful candidate will hold an active, unrestricted RN license, 3+ years of RN experience (including Med/Surg), and proficiency with Microsoft Office.

After training, you’ll work a 4‑day weekend schedule, with some evenings and holidays, in a HIPAA‑compliant home office.

Qualifikationen

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience.
• 1+ year Med/Surg experience.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).
• Willingness to work required schedule post-training.
• Prior Authorization or Utilization Management experience.
• Managed care experience.
• MedCompass experience.
• Ambulatory surgery background.
• BSN preferred (Associate’s required).

Aufgaben

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines, policies, and sound judgment across the care continuum.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to enhance quality, efficiency, and member outcomes.
• Refer members to additional programs and services as appropriate.
• Serve as a clinical resource within utilization/benefit management.

Kenntnisse

Active RN license

3+ years RN experience

Med/Surg experience

Microsoft Office proficiency

Schedule flexibility

Ausbildung

Associate’s degree

BSN preferred

Tools

Microsoft Office 365

VPN access

EHR systems

Jobbeschreibung

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations and care coordination from a remote, full-time role with weekend shifts. The successful candidate will hold an active, unrestricted RN license, 3+ years of RN experience (including Med/Surg), and proficiency with Microsoft Office.

After training, you’ll work a 4‑day weekend schedule, with some evenings and holidays, in a HIPAA‑compliant home office.