Remote Utilization Management RN Consultant

CVS Health; Provo (UT); Remote; USD 36,000 - 95,000; Full time

Job summary

CVS Health is recruiting a Medicare Precertification Utilization Management Nurse Consultant. The role supports a 24/7 utilization management operation with hybrid or remote options, requiring an active RN license, 3+ years of RN experience, and 1+ year in Med/Surg.

Proficiency with Microsoft Office is expected. Responsibilities include assessing care options, applying criteria for coverage decisions, and coordinating with providers to optimize patient outcomes.

Qualifications

• Active RN license in state of residence.
• ~3+ years of Registered Nurse experience.
• ~1+ year of Med/Surg clinical experience.
• ~1+ year of experience with Microsoft Office applications (Outlook, Teams, Excel).

Responsibilities

• Assess, plan, implement, coordinate and evaluate care to facilitate appropriate healthcare services/benefits.
• Gather clinical information and apply guidelines to render coverage determinations.
• Communicate with providers and other parties to coordinate care.
• Identify members for referral opportunities to support integrated care programs.
• Collaborate with internal/external stakeholders in utilization/benefit management.

Skills

RN experience

RN licensure

Med/Surg experience

Microsoft Office (Outlook/Teams/Excel)

Education

Associates degree

BSN preferred

Tools

Microsoft Office

EHR/MedCompass experience

Job description

CVS Health is recruiting a Medicare Precertification Utilization Management Nurse Consultant. The role supports a 24/7 utilization management operation with hybrid or remote options, requiring an active RN license, 3+ years of RN experience, and 1+ year in Med/Surg.

Proficiency with Microsoft Office is expected. Responsibilities include assessing care options, applying criteria for coverage decisions, and coordinating with providers to optimize patient outcomes.