Remote RN: Utilization Management & Care Coordination

CVS Health; Columbia (SC); Remote; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced Registered Nurse (RN) for Utilization Management to support a 24/7 team. You will review cases, assess medical necessity, coordinate care, and collaborate with providers to optimize outcomes.

You’ll leverage acute care experience and clinical judgment to ensure members receive the right care at the right time, while adhering to HIPAA guidelines and corporate standards.

Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years of RN experience in an adult acute care or critical care setting.
• Associate Degree in Nursing (ADN).
• Strong communication, multitasking, and computer skills.
• Ability to work a flexible schedule, including evenings, weekends, and holidays.

Responsibilities

• Review clinical information and apply evidence-based criteria to make coverage recommendations.
• Collaborate with providers and interdisciplinary teams to support care coordination.
• Identify opportunities to improve quality, outcomes, and healthcare resource utilization.
• Refer members to appropriate programs and services that support their healthcare needs.
• Serve as a clinical resource for internal and external stakeholders.

Skills

Active RN license

RN experience (adult acute/critical)

Strong communication

Multitasking and computer skills

Education

Associate Degree in Nursing (ADN)

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is seeking an experienced Registered Nurse (RN) for Utilization Management to support a 24/7 team. You will review cases, assess medical necessity, coordinate care, and collaborate with providers to optimize outcomes.

You’ll leverage acute care experience and clinical judgment to ensure members receive the right care at the right time, while adhering to HIPAA guidelines and corporate standards.