Remote Inpatient Utilization Nurse (RN)

CVS Health Corporation; Austin (TX); Remote; USD 74,612,000 - 160,864,000; Full time

Benefits offered by this job

Fully remote work environment

Impactful care quality work

Job summary

CVS Health Corporation is seeking a Concurrent Review Nurse (RN) for a 100% remote role. The position involves reviewing inpatient stays, collaborating with care teams, and ensuring appropriate care levels in a remote setting.

Requires 5+ years inpatient nursing, strong assessment and communication, and eligibility for multi-state licensure. Standard schedule is Mon–Fri 8:00 AM–5:00 PM CST with occasional weekend and holiday on-call coverage.

Qualifications

• Active, unrestricted RN license with Louisiana licensure or Compact RN licensure.
• Ability and willingness to obtain additional state licensure as required.
• 5+ years of inpatient clinical nursing experience.
• Strong clinical assessment, critical-thinking, and communication skills.
• Ability to participate in rotating weekend coverage and holiday on-call schedules.

Responsibilities

• Conduct concurrent reviews for inpatient admissions and continued stays.
• Evaluate clinical documentation and determine medical necessity using established guidelines and evidence-based criteria.
• Collaborate with hospitals, physicians, utilization review departments, and care teams to support appropriate levels of care.
• Facilitate timely discharge planning and care transitions.
• Monitor ongoing inpatient treatment and identify opportunities to improve healthcare utilization and outcomes.
• Communicate recommendations and clinical findings to providers and internal stakeholders.
• Support effective resource utilization while maintaining quality and compliance standards.

Skills

RN licensure

Clinical assessment

Critical thinking

Communication

Weekend on-call

Education

Associates Degree

Bachelor's preferred

Tools

MCG

InterQual

Job description

CVS Health Corporation is seeking a Concurrent Review Nurse (RN) for a 100% remote role. The position involves reviewing inpatient stays, collaborating with care teams, and ensuring appropriate care levels in a remote setting.

Requires 5+ years inpatient nursing, strong assessment and communication, and eligibility for multi-state licensure. Standard schedule is Mon–Fri 8:00 AM–5:00 PM CST with occasional weekend and holiday on-call coverage.