RN Utilization & Quality Care Consultant (Remote)

CVS Health; Charlotte (NC); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced RN Utilization Management Nurse Consultant for Medicare joint procedures. This remote, full-time role follows a Monday–Friday schedule (9:00 am–5:30 pm in your time zone) with occasional evenings/holidays, leveraging your clinical expertise to ensure members receive appropriate care.

You will review clinical data for precertifications, apply criteria, coordinate with providers, and drive care quality while supporting patient access to additional programs and

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years of RN experience.
• 1+ year of Med/Surg experience.
• Proficiency in Microsoft Office (Outlook, Teams, Excel).
• Associates degree in nursing.

Responsibilities

• Review and assess clinical information for Medicare precertification (joint procedures).
• Apply evidence-based criteria and clinical judgment to make coverage determinations.
• Collaborate with providers and care teams to coordinate appropriate treatment plans.
• Identify opportunities to improve care quality and optimize healthcare utilization.
• Support care integration by connecting members to additional programs and services.
• Serve as a clinical resource to internal and external partners.

Skills

RN license

RN experience

Med/Surg experience

Microsoft Office 365

Education

Associates degree in nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking an experienced RN Utilization Management Nurse Consultant for Medicare joint procedures. This remote, full-time role follows a Monday–Friday schedule (9:00 am–5:30 pm in your time zone) with occasional evenings/holidays, leveraging your clinical expertise to ensure members receive appropriate care.

You will review clinical data for precertifications, apply criteria, coordinate with providers, and drive care quality while supporting patient access to additional programs and