Utilization Management Nurse Consultant

CVS Health
Washington, District of Columbia, United States
Full Time
Remote
Mid
USD 54,101 – 129,626
Associate Degree
Healthcare Healthcare Life Sciences

Posted 1 week ago

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Excellent 4.7

Job summary

The RN Utilization Management Nurse Consultant reviews clinical information for Medicare precertification, applies evidence-based criteria to make coverage decisions, collaborates with providers to coordinate treatment, and supports care quality and utilization improvement in a remote, full-time role.

Responsibilities

The Utilization Management Nurse Consultant reviews and assesses clinical information for Medicare precertification to ensure members receive appropriate care. They collaborate with providers and care teams to coordinate treatment plans and identify opportunities to optimize healthcare utilization.

Qualifications

care coordination care quality improvement clinical assessment collaboration with providers evidence-based criteria application healthcare utilization optimization interpersonal skills medicare knowledge RN license system navigation

Candidates must hold an active, unrestricted RN license in their state of residence with at least 3 years of RN experience and 1 year of Med/Surg experience. Proficiency in Microsoft Office and the ability to maintain a secure, high-speed home office environment are required.

English

Benefits

  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs

Company

CVS Health

CVS Health

linkedin
Hospitals and Health Care
Location
Washington, District of Columbia, United States

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Excellent 4.7
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