{"version":"0.1","company":{"name":"YubHub","url":"https://yubhub.co","jobsUrl":"https://yubhub.co/jobs/city/work-at-home-georgia/"},"x-facet":{"type":"city","slug":"work-at-home-georgia","display":"Work At Home-georgia","count":1},"x-feed-size-limit":100,"x-feed-sort":"enriched_at desc","x-feed-notice":"This feed contains at most 100 jobs (the most recently enriched). For the full corpus, use the paginated /stats/by-facet endpoint or /search.","x-generator":"yubhub-xml-generator","x-rights":"Free to redistribute with attribution: \"Data by YubHub (https://yubhub.co)\"","x-schema":"Each entry in `jobs` follows https://schema.org/JobPosting. YubHub-native raw fields carry `x-` prefix.","jobs":[{"@context":"https://schema.org","@type":"JobPosting","identifier":{"@type":"PropertyValue","name":"YubHub","value":"job_48ee12e4-c9c"},"title":"Medicare Predetermination Utilization Management Nurse Consultant","description":"<p>We&#39;re building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.</p>\n<p>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.</p>\n<p>Responsibilities:</p>\n<ul>\n<li>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.</li>\n<li>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.</li>\n<li>Communicates with providers and other parties to facilitate care/treatment.</li>\n<li>Identifies members for referral opportunities to integrate with other products, services and/or programs.</li>\n<li>Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.</li>\n<li>Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.</li>\n</ul>\n<p>Requirements:</p>\n<ul>\n<li>3+ years of experience as a Registered Nurse.</li>\n<li>Active current and unrestricted RN licensure in state of residence.</li>\n<li>1+ years of Med/Surg experience.</li>\n<li>1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).</li>\n<li>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.</li>\n</ul>\n<p>Preferred Qualifications:</p>\n<ul>\n<li>Prior Authorization or Utilization Management experience.</li>\n<li>Managed care experience.</li>\n<li>Experience using MedCompass.</li>\n<li>Ambulatory surgery experience.</li>\n<li>Medicare experience.</li>\n</ul>\n<p>Education:</p>\n<ul>\n<li>Associates degree required.</li>\n<li>BSN preferred.</li>\n</ul>\n<p>Benefits:</p>\n<ul>\n<li>Medical, dental, and vision coverage.</li>\n<li>Paid time off.</li>\n<li>Retirement savings options.</li>\n<li>Wellness programs.</li>\n</ul>\n<p>Salary Range: $26.01 - $68.55 per hour.</p>\n<p style=\"margin-top:24px;font-size:13px;color:#666;\">Job Data by <a href=\"https://yubhub.co\">YubHub</a>.</p>","url":"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","directApply":true,"hiringOrganization":{"@type":"Organization","name":"CVS Health","sameAs":"https://cvshealth.com","logo":"https://logos.yubhub.co/cvshealth.com.png"},"x-apply-url":"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","x-work-arrangement":null,"x-experience-level":"senior","x-job-type":"full-time","x-salary-range":"$26.01 - $68.55","x-skills-required":["Registered Nurse","Microsoft Office","Med/Surg experience"],"x-skills-preferred":["Prior Authorization","Utilization Management","Managed care","MedCompass","Ambulatory surgery","Medicare"],"x-benefits":["pension","health_insurance","dental","paid_leave","bonus"],"x-licences":["RN licence"],"x-visa-sponsorship":"unknown","x-visa-sponsorship-text":null,"x-work-authorisation":"unknown","x-work-authorisation-text":null,"datePosted":"2026-11-04T00:00:00.000Z","jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Work At Home-Georgia"}},"employmentType":"FULL_TIME","occupationalCategory":"Healthcare","industry":"Healthcare","skills":"Registered Nurse, Microsoft Office, Med/Surg experience, Prior Authorization, Utilization Management, Managed care, MedCompass, Ambulatory surgery, Medicare"}]}