Remote RN Utilization & Care Coordination Consultant

CVS Health; Maryland City (MD); Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Comprehensive benefits package

Remote work

Paid time off

Wellness programs

Job summary

CVS Health is seeking a Registered Nurse for Utilization Management to assess and coordinate care for members. You will review clinical information, apply guidelines, and render coverage determinations while communicating with providers to facilitate treatment. The role emphasizes HIPAA-compliant care, collaboration, and efficient use of resources.

Requires an active RN license, ADN (BSN preferred), and 2+ years in adult acute/critical care. Remote work within the U.S.

Qualifications

• Active RN license in state of residence
• 2+ years RN experience in adult acute/critical care
• Ability to work weekends, holidays, and evenings as needed
• Proficiency with HIPAA guidelines and secure data handling

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate healthcare services for members
• Render coverage determinations/recommendations using clinical criteria and guidelines
• Communicate with providers to facilitate care and treatment
• Identify referral opportunities and promote program utilization

Skills

RN experience in adult acute/critical

Active RN license

Weekend/holidays/evening availability

HIPAA knowledge

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Tools

EHR systems

VPN access / secure portals

Microsoft Office 365

Job description

CVS Health is seeking a Registered Nurse for Utilization Management to assess and coordinate care for members. You will review clinical information, apply guidelines, and render coverage determinations while communicating with providers to facilitate treatment. The role emphasizes HIPAA-compliant care, collaboration, and efficient use of resources.

Requires an active RN license, ADN (BSN preferred), and 2+ years in adult acute/critical care. Remote work within the U.S.