Medicare Precertification Utilization Management Nurse Consultant (RN)
Remote | Full-Time | Weekends
Are you a detail-oriented RN passionate about improving healthcare outcomes? Join our Utilization Management team and play a key role in ensuring members receive the right care at the right time.
What You'll Do
- Review and assess clinical information to support coverage determinations
- Apply clinical guidelines, policies, and sound judgment across the care continuum
- Collaborate with providers and care teams to coordinate treatment plans
- Identify opportunities to enhance quality, efficiency, and member outcomes
- Refer members to additional programs and services as appropriate
- Serve as a clinical resource within utilization/benefit management
Schedule
- Training: Monday–Friday, 8:30 AM–5:00 PM (EST)
- After training: 4-day WEEKEND schedule (Friday–Monday, 10-hour shifts)
- Includes evening hours and occasional holidays (24/7 operation)
Required Qualifications
- Active, unrestricted RN license in state of residence
- 3+ years of RN experience
- 1+ year Med/Surg experience
- Proficiency with Microsoft Office (Outlook, Teams, Excel)
- Willingness to work required schedule post-training
Preferred Qualifications
- Prior Authorization or Utilization Management experience
- Managed care experience
- MedCompass experience
- Ambulatory surgery background
- BSN preferred (Associate's required)
Work from Home Requirements
- You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
- A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
- The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
- If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.
Technical and Logistical Requirements
- Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
- Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
- Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
- Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
- Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
- Future Growth: Openness to learning new skills in the future as the workplace environment evolves.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is
$26.01 - $62.32