Remote RN Concurrent Review Specialist

CVS Health Corporation; Baton Rouge (LA); Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health Corporation is seeking an experienced RN Concurrent Review Nurse for a remote, full-time role in Louisiana. You will review clinical information to determine medical necessity and coordinate care across the continuum.

The ideal candidate holds an active RN license in Louisiana, has 5+ years of inpatient nursing experience, and 2+ years in utilization management or related fields. BSN is preferred. This is a remote, full-time position with standard C.V.S. Health benefits.

Qualifications

• Active, unrestricted Louisiana or Compact RN license required.
• Must be willing to obtain additional state licenses as needed.
• 5+ years of inpatient clinical nursing experience.
• 2+ years of Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review experience.
• Associate’s degree in nursing required. BSN preferred.

Responsibilities

• Review clinical information and apply medical necessity criteria and clinical judgment to coverage recommendations.
• Collaborate with providers and internal teams to coordinate appropriate care and discharge planning.
• Identify opportunities for care management referrals and improved healthcare utilization.
• Support timely, effective care for members across the continuum.

Skills

RN license

Inpatient nursing

Utilization Management

Discharge Planning

Communication

Education

Associate degree in nursing

BSN

Tools

Microsoft 365

Job description

CVS Health Corporation is seeking an experienced RN Concurrent Review Nurse for a remote, full-time role in Louisiana. You will review clinical information to determine medical necessity and coordinate care across the continuum.

The ideal candidate holds an active RN license in Louisiana, has 5+ years of inpatient nursing experience, and 2+ years in utilization management or related fields. BSN is preferred. This is a remote, full-time position with standard C.V.S. Health benefits.