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QM Nurse Associate


Entry Level


Not defined

12 Nov → 12 Dec

CVS Health

Woonsocket, RI 02895, USA

About Company

CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners.
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Job Description

Working hours will be Monday-Friday 8am-5pm with the ability to work a late shift as needed.

No weekend or travel is required.

Holidays may be required on rotation.

This role is open to Telework anywhere! Preference for candidates in PST, CST or MST.

COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.


Job Responsibilities

  • This critical position supports the Utilization Management Organization Determination (OD) SNF/LTAC/Rehab team
  • Utilization of clinical skills to support the documentation and communication of medical services and/or benefit administration determinations.
  • Ability to review Medicare pre-service correspondence to assure denial letter language compliance with CMS requirements; the provision of alternate wording when necessary.
  • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

Requirements / Qualifications

  • Minimum of 2+ years clinical experience required
  • Minimum 1+ year of Medicare experience
  • LPN/LVN with current unrestricted state licensure required

How To Apply

Apply through GoRemotely.

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