Remote RN - Utilization Management & Care Coordination

CVS Health

Harrisburg (Dauphin County)

Remote

USD 36,000 - 103,000

Full time

2 days ago

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Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health is seeking an experienced Registered Nurse (RN) to join our Utilization Management team. The role focuses on reviewing cases, supporting coverage determinations, coordinating care, and ensuring members receive appropriate services across the care continuum.

The ideal candidate has an Active RN license, 2+ years in adult acute or critical care, and strong communication and multitasking skills. This full-time role requires the ability to work in a 24/7 operation and adhere to HIPAA

Qualifications

Active RN license in your state of residence.
2+ years RN experience in adult acute or critical care.
Strong communication and critical thinking abilities.
Proficiency navigating multiple computer systems.
BSN preferred.

Responsibilities

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