Remote RN Quality & Utilization Consultant

CVS Health; Alabama; Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health seeks an experienced RN to assess, plan, implement and coordinate patient care and benefits for members, applying clinical criteria to determine coverage. You will collaborate with providers and teams to optimize utilization and outcomes while maintaining HIPAA compliance.

The role requires an active RN license, 2+ years in adult acute/critical care, and availability for weekend/holiday hours in a full-time, remote-capable position within Alabama.

Qualifications

• Active RN license in their state of residence is required.
• 2+ years of RN experience in adult acute/critical care.
• Available to work weekends, holidays, and evenings as needed.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Apply clinical criteria and guidelines to render coverage determinations and recommendations.
• Communicate with providers and other parties to facilitate care and treatment.
• Collaborate with internal/external constituents in utilization/benefit management.
• Maintain HIPAA-compliant, secure home-work environment and proficient computer use.

Skills

RN license

Clinical experience

Weekend availability

Education

Associates Degree in Nursing

Bachelor's Degree in Nursing

Tools

Microsoft Office 365

Job description

CVS Health seeks an experienced RN to assess, plan, implement and coordinate patient care and benefits for members, applying clinical criteria to determine coverage. You will collaborate with providers and teams to optimize utilization and outcomes while maintaining HIPAA compliance.

The role requires an active RN license, 2+ years in adult acute/critical care, and availability for weekend/holiday hours in a full-time, remote-capable position within Alabama.