Remote RN: Utilization & Care Management

CVS Health; Alabama; Hybrid; USD 36,000 - 95,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Work-from-home setup provided

Job summary

CVS Health is seeking an experienced registered nurse to assess, plan, implement, and coordinate patient care and benefits for members. You will evaluate clinical information to determine coverage decisions and collaborate with providers to facilitate treatment across the continuum of care.

The role requires active RN licensure, 2+ years in adult acute/critical care, and availability on weekends, holidays, and evenings.

Qualifications

• Must have active RN license in state of residence and 2+ years of experience in adult acute care/critical care.
• Associates degree or nursing diploma required.
• Willingness to work weekends, holidays, and evenings as needed.
• Proficient in navigating multiple systems and keyboarding; strong verbal and written communication.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate healthcare services/benefits for members.
• Render coverage determinations/recommendations using clinical criteria/guidelines.
• Coordinate with providers and other parties to facilitate care and treatment.
• Promote quality and efficiency of healthcare services and benefit utilization.
• Collaborate with internal/external constituents in utilization/benefit management.

Skills

Clinical judgment

Communication

Multitasking

Computer skills

Team collaboration

Education

Associates Degree in Nursing or Nursing Diploma

Tools

EHR/EMR systems (Epic)

Job description

CVS Health is seeking an experienced registered nurse to assess, plan, implement, and coordinate patient care and benefits for members. You will evaluate clinical information to determine coverage decisions and collaborate with providers to facilitate treatment across the continuum of care.

The role requires active RN licensure, 2+ years in adult acute/critical care, and availability on weekends, holidays, and evenings.