Remote RN: Utilization & Care Coordination Nurse

CVS Health Corporation; Jackson (MS); Hybrid; USD 36,000 - 77,000; Full time

Job summary

CVS Health Corporation is seeking an RN Concurrent Review Nurse for a remote role. You will use inpatient clinical expertise to ensure members receive appropriate, medically necessary care throughout the continuum of care.

The position requires an active Louisiana or Compact RN license, 5+ years inpatient experience, and 2+ years in utilization management or related fields. A BSN is preferred and work-from-home requirements are outlined in detail.

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 in Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review.
• 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 experience

Utilization Management

Case Management

Education

Associate’s degree in nursing

BSN preferred

Tools

Microsoft 365

Job description

CVS Health Corporation is seeking an RN Concurrent Review Nurse for a remote role. You will use inpatient clinical expertise to ensure members receive appropriate, medically necessary care throughout the continuum of care.

The position requires an active Louisiana or Compact RN license, 5+ years inpatient experience, and 2+ years in utilization management or related fields. A BSN is preferred and work-from-home requirements are outlined in detail.