Remote RN: Acute Inpatient Utilization Mgmt

Santa Barbara Cottage Hospital; United States; Remote; USD 48,000 - 65,000; Full time

Job summary

CVS Health is seeking an experienced RN for remote acute inpatient Utilization Management to ensure quality, appropriate care, and efficient hospital stays through concurrent review and care coordination.

You will evaluate medical necessity using evidence-based criteria, collaborate with hospital staff and discharge planners, and manage a high-volume caseload while maintaining quality and timely decisions from a central remote work setup.

Qualifications

• Active, unrestricted RN license in your state of residence.
• Ability to obtain and maintain additional state licensure as required.
• 5+ years of acute care nursing experience.
• 2+ years of Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review experience.
• Experience reviewing acute inpatient admissions and continued stay requests.
• Experience applying MCG or similar evidence-based clinical criteria.
• Knowledge of inpatient hospital operations, discharge planning, and transitions of care.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Excellent written and verbal communication skills.
• Proficiency with electronic medical records and utilization management systems.

Responsibilities

• Perform concurrent reviews for acute inpatient admissions and continued hospital stays.
• Evaluate medical necessity, severity of illness, intensity of service, and level of care using evidence-based clinical criteria.
• Collaborate with hospitals, physicians, care managers, and discharge planners to support appropriate treatment and timely transitions of care.
• Review clinical documentation and apply health plan benefits and regulatory requirements to authorization decisions.
• Partner with Medical Directors on complex cases and escalations.
• Facilitate discharge planning and identify opportunities to optimize care and resource utilization.
• Manage a high-volume caseload while meeting quality, productivity, and turnaround-time standards.

Skills

RN licensure

Acute care nursing

Utilization Management

Concurrent Review

Discharge planning

Care coordination

Evidence-based criteria

EMR systems

Communication skills

Decision making

Education

ASN

BSN preferred

Tools

EMR systems

Job description

CVS Health is seeking an experienced RN for remote acute inpatient Utilization Management to ensure quality, appropriate care, and efficient hospital stays through concurrent review and care coordination.

You will evaluate medical necessity using evidence-based criteria, collaborate with hospital staff and discharge planners, and manage a high-volume caseload while maintaining quality and timely decisions from a central remote work setup.