Remote RN: Utilization & Care Coordination

4004 Aetna Medicaid Administrators; Mississippi; Hybrid; USD 54,000 - 117,000; Full time

Benefits offered by this job

Benefits package

Bonus program

Job summary

CVS Health is recruiting for an RN Concurrent Review Nurse in a remote capacity, focusing on inpatient clinical expertise to ensure medically necessary care across the continuum.

The role requires an active RN license and 5+ years of inpatient nursing experience, with a preference for BSN. You will collaborate with providers, coordinate discharge planning, and participate in care management referrals to optimize utilization and outcomes.

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.

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

Inpatient nursing

Utilization management

Discharge planning

Care coordination

Clinical judgment

Education

Associate's degree in nursing

BSN preferred

Tools

Microsoft 365

Job description

CVS Health is recruiting for an RN Concurrent Review Nurse in a remote capacity, focusing on inpatient clinical expertise to ensure medically necessary care across the continuum.

The role requires an active RN license and 5+ years of inpatient nursing experience, with a preference for BSN. You will collaborate with providers, coordinate discharge planning, and participate in care management referrals to optimize utilization and outcomes.