Remote Utilization Management RN Consultant

CVS Health; Alabama; A distancia; USD 36.000 - 86.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical

Dental

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Descripción de la vacante

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join our remote team. You will review clinical information to determine appropriate coverage and apply guidelines to support sound medical decisions while coordinating with care teams.

This role requires flexibility for weekend shifts and after-training schedules. The ideal candidate holds an active RN license, has Med/Surg experience, and is proficient in Microsoft Office.

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

Attention to detail

Microsoft Office proficiency

Herramientas

Microsoft Office (Outlook, Teams, Excel)

Descripción del empleo

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join our remote team. You will review clinical information to determine appropriate coverage and apply guidelines to support sound medical decisions while coordinating with care teams.

This role requires flexibility for weekend shifts and after-training schedules. The ideal candidate holds an active RN license, has Med/Surg experience, and is proficient in Microsoft Office.