# Medicare Predetermination Utilization Management Nurse Consultant

**Company**: CVS Health
**Location**: Work At Home-Georgia
**Experience**: senior
**Job type**: full-time
**Salary**: $26.01 - $68.55
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/Work-At-Home-Georgia/Utilization-Management-Nurse-Consultant---Weekends-S-S-M-T---4-10-hour-shifts-_R1069063-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_48ee12e4-c9c

## Description

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Medicare Predetermination Utilization Management Nurse Consultant position involves utilizing clinical experience and skills to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

Responsibilities:

- Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.

- Communicates with providers and other parties to facilitate care/treatment.

- Identifies members for referral opportunities to integrate with other products, services and/or programs.

- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.

- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Requirements:

- 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).

- Must be willing and able to work Saturday, Sunday, Monday and Tuesday 10 hr shifts after approximately 4-5 months of training Monday - Friday 7:30am-6pm EST with occasional holiday rotation.

Preferred Qualifications:

- Prior Authorization or Utilization Management experience.

- Managed care experience.

- Experience using MedCompass.

- Ambulatory surgery experience.

- Medicare experience.

Education:

- Associates degree required.

- BSN preferred.

Benefits:

- Medical, dental, and vision coverage.

- Paid time off.

- Retirement savings options.

- Wellness programs.

Salary Range: $26.01 - $68.55 per hour.

For more fresh new jobs, check out [yubhub.co](https://yubhub.co/).

## Skills

### Required
- Registered Nurse
- Microsoft Office
- Med/Surg experience

### Nice to have
- Prior Authorization
- Utilization Management
- Managed care
- MedCompass
- Ambulatory surgery
- Medicare

---

Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/Work-At-Home-Georgia/Utilization-Management-Nurse-Consultant---Weekends-S-S-M-T---4-10-hour-shifts-_R1069063-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)