RN Utilization Management Consultant - Medicare (Remote)

CVS Health; Illinois; Remote; USD 36.000 - 94.000; Vollzeit

Benefits dieser Stelle

Bonus program

Zusammenfassung

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant to join our 24/7 team. The role requires RN licensure, 3+ years of experience, and familiarity with MS Office tools.

Schedule is Monday–Friday, with holidays and evenings in the candidate's time zone, and work-from-home options within the state. You'll assess care options, gather clinical information, communicate with providers, and coordinate care to ensure appropriate benefits and services while upholding

Qualifikationen

• 3+ years of experience as a Registered Nurse.
• Active current and unrestricted RN licensure in state of residence.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).

Aufgaben

• Assess and coordinate care to facilitate appropriate healthcare services.
• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to coordinate care.
• Identify referral opportunities to integrate with other programs.
• Promote quality and effective use of healthcare services.
• Consult with internal and external stakeholders on utilization management.

Kenntnisse

Registered Nurse

Med/Surg experience

Clinical coordination

Ausbildung

Associates degree

BSN preferred

Tools

Microsoft Office

Jobbeschreibung

CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant to join our 24/7 team. The role requires RN licensure, 3+ years of experience, and familiarity with MS Office tools.

Schedule is Monday–Friday, with holidays and evenings in the candidate's time zone, and work-from-home options within the state. You'll assess care options, gather clinical information, communicate with providers, and coordinate care to ensure appropriate benefits and services while upholding