Remote Inpatient Utilization Nurse (RN)

CVS Health Corporation; United States; À distance; USD 74 530 000 - 160 258 000; Plein temps

Avantages offerts par ce poste

Fully remote work environment

Comprehensive benefits package

Bonus eligibility

Résumé du poste

CVS Health is seeking a Concurrent Review Nurse (RN) for a 100% remote role. In this inpatient-focused position, you will review admissions and ongoing stays to ensure appropriate, high-quality, cost-effective care across the patient journey.

You will collaborate with hospitals, physicians, and care teams, participate in rotating weekend and holiday on-call coverage, and leverage evidence-based guidelines (MCG/InterQual) while pursuing Louisiana licensure and potential additional state

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

Responsabilités

• 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

Connaissances

Inpatient nursing

Clinical assessment

Critical thinking

Communication

Rotating weekends/holidays

Formation

Associate degree in Nursing

Bachelor's degree preferred

Outils

MCG (Milliman Care Guidelines)

InterQual

Description du poste

CVS Health is seeking a Concurrent Review Nurse (RN) for a 100% remote role. In this inpatient-focused position, you will review admissions and ongoing stays to ensure appropriate, high-quality, cost-effective care across the patient journey.

You will collaborate with hospitals, physicians, and care teams, participate in rotating weekend and holiday on-call coverage, and leverage evidence-based guidelines (MCG/InterQual) while pursuing Louisiana licensure and potential additional state