Remote RN Utilization Management – Acute Inpatient Review

CVS Health; Baton Rouge (LA); A distancia; USD 36.000 - 77.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Benefits package

Remote work option

Descripción de la vacante

CVS Health is seeking an experienced Utilization Management RN for remote concurrent review of acute inpatient stays. The role focuses on clinical effectiveness, appropriate care levels, and collaboration with care teams to optimize transitions.

Requirements include 5+ years of acute care nursing and 2+ years in utilization management, with ASN and BSN preferred. This remote role supports Louisiana Medicaid populations and requires strong communication skills.

Formación

• Active, unrestricted RN license in your state of residence.
• 5+ years of acute care nursing experience.
• 2+ years of Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review experience.
• Experience applying MCG or similar evidence‑based criteria.

Responsabilidades

• Perform concurrent reviews for acute inpatient admissions and continued hospital stays.
• Evaluate medical necessity, severity of illness, intensity of service, and level of care using evidence‑based clinical criteria.
• Collaborate with hospitals, physicians, care managers, and discharge planners to support appropriate treatment and timely transitions of care.
• Review clinical documentation and apply health plan benefits and regulatory requirements to authorization decisions.
• Partner with Medical Directors on complex cases and escalations.
• Facilitate discharge planning and identify opportunities to optimize care and resource utilization.
• Manage a high‑volume caseload while meeting quality, productivity, and turnaround‑time standards.

Conocimientos

Communication

Critical thinking

Decision making

Team collaboration

Written/verbal communication

Educación

ASN

BSN preferred

Herramientas

Microsoft Office 365

EMR systems

Utilization management systems

Descripción del empleo

CVS Health is seeking an experienced Utilization Management RN for remote concurrent review of acute inpatient stays. The role focuses on clinical effectiveness, appropriate care levels, and collaboration with care teams to optimize transitions.

Requirements include 5+ years of acute care nursing and 2+ years in utilization management, with ASN and BSN preferred. This remote role supports Louisiana Medicaid populations and requires strong communication skills.