RN Utilization Management Consultant - Remote

CVS Health; Kailua (HI); Remote; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to join our team. This remote role offers a 40-hour work week with a Monday–Friday schedule and occasional holidays/evening hours in the candidate's time zone.

You will assess care needs, apply clinical criteria, and coordinate with providers to determine coverage and appropriate services for members. Strong RN background and Med/Surg experience are essential.

Qualifications

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

Responsibilities

• Utilizes clinical experience to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies criteria/guideline to render coverage determinations/recommendations.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other products/services.
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consults and lends expertise to coordination and administration of utilization/benefit management.

Skills

RN Experience

Med/Surg Experience

Education

Associates degree

BSN

Tools

Microsoft Office

Job description

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to join our team. This remote role offers a 40-hour work week with a Monday–Friday schedule and occasional holidays/evening hours in the candidate's time zone.

You will assess care needs, apply clinical criteria, and coordinate with providers to determine coverage and appropriate services for members. Strong RN background and Med/Surg experience are essential.