# 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-_R1095893?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/medicare-predetermination-utilization-management-752302b1-42f/

## 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 in a collaborative process 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.

**Required Qualifications**

- 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 approx 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 is a must.

**Education**

- Associates degree required.

- BSN preferred.

**Benefits**

- Medical, dental, and vision coverage.

- Paid time off.

- Retirement savings options.

- Wellness programs.

**Pay Range**

- $26.01 - $68.55

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## Skills

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

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

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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-_R1095893?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)