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Utilization Management Nurse Consultant
CVS Health. Review and assess clinical information for Medicare precertification involving joint procedures .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical assessment and coverage determination for Medicare precertification, utilizing evidence-based criteria and clinical judgment. Proficient in coordinating treatment plans and improving care quality while ensuring compliance with HIPAA guidelines.
Highest-signal resume keywords
Active RN License3+ Years RN ExperienceMed/Surg ExperienceMicrosoft Office ProficiencyEHR Portal Access
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical AssessmentCoverage DeterminationEvidence-Based Criteria ApplicationCare CoordinationHealthcare Utilization OptimizationTechnical TroubleshootingMultiple Application NavigationVPN AccessHIPAA CompliancePatient Care Integration
Soft Skills
CollaborationCommunicationAdaptabilityProblem-SolvingOpenness to Learning
Tools & Technologies
Microsoft Office 365Google WorkspaceEHR SystemsSecure Systems AccessInternet Connection Compliance
Certifications & Qualifications
RN License
Industry Keywords
MedicareClinical ResourceCare Quality ImprovementHealthcare ServicesPrecertification
About the role
Key responsibilities & impact- Review and assess clinical information for Medicare precertification involving 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
- Connect members to additional programs and services to support care integration
- Serve as a clinical resource to internal and external partners
- Work Monday–Friday from 9:00 am to 5:30 pm in the employee’s time zone, with occasional evenings and holidays
- Work remotely from a designated home workspace
Requirements
What you’ll need- 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)
- Associate degree in nursing
- Must work within the state and city where currently living
- Direct/hardwired internet connection to a modem/router within 7 feet of the computer
- Minimum internet speed of 25 Mbps download and 3 Mbps upload
- WiFi and satellite internet are not permitted
- Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
- Ability to use multiple monitors and navigate multiple applications simultaneously
- Ability to use Microsoft Office 365 applications or similar Google Workspace tools
- Ability to access secure systems such as VPN and EHR portals
- Ability to follow computer, password, and email security practices
- Ability to troubleshoot common technical issues
- Openness to learning new skills as the workplace evolves
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- Company-provided equipment (keyboard, monitor, computer, headset, etc.)
- Remote work from home
- Consistent weekday schedule with some flexibility for a 24/7 operation