Remote Utilization Management RN Consultant

CVS Health; Crystal Bay (NV); Remote; USD 40,000 - 86,000; Full time

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) to support treatment decisions remotely. You will collaborate with providers and apply clinical judgment for the right care at the right time.

An active RN license and at least 3 years of RN experience (including medical-surgical), with UM/PA and managed care familiarity. Proficiency in Microsoft Office and Teams is expected.

Qualifications

• Active, unrestricted RN license in state of residence.
• Minimum 3 years RN experience, including at least 1 year in Medical-Surgical Nursing.
• Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel.
• Associate Degree in Nursing (ADN).
• Ability to work Monday-Friday, 9:00 AM-5:30 PM in your local time zone.
• Utilization Management, Prior Authorization, or Care Management experience.
• Managed care experience.
• Experience using MedCompass or similar UM platforms.
• Ambulatory surgery or outpatient clinical experience.
• Bachelor of Science in Nursing (BSN).

Responsibilities

• Collaborate with providers and interdisciplinary care teams to support treatment planning.
• Apply clinical judgement to utilization management and prior authorization decisions.
• Identify opportunities to improve quality, outcomes, and member experience.
• Serve as a trusted clinical resource for internal and external stakeholders.

Skills

RN license

Medical-Surgical nursing

Utilization management

Prior authorization

Care management

Managed care

Remote collaboration

Team communication

Education

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Tools

MedCompass

Microsoft 365 / Teams / Outlook / Excel

Job description

CVS Health is seeking a Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) to support treatment decisions remotely. You will collaborate with providers and apply clinical judgment for the right care at the right time.

An active RN license and at least 3 years of RN experience (including medical-surgical), with UM/PA and managed care familiarity. Proficiency in Microsoft Office and Teams is expected.