Remote RN: Utilization Management & Care Coordination

CVS Health; Harrisburg (Dauphin County); On-site; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical benefits

Dental and vision

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring for a full-time, work-from-home Utilization Management Nurse. You will assess, plan, implement, and coordinate healthcare services for members using clinical criteria and collaboration with providers. A valid RN license in the state of residence is required.

The role emphasizes communication, multitasking, and adherence to UM/CM guidelines while ensuring quality outcomes. Weekend coverage is required, with a competitive benefits package and base pay range.

Qualifications

• Active RN license in state of residence.
• 3+ years of RN experience in acute or post-acute settings.
• 1+ year of Utilization Management/Care Management experience.
• May be required to obtain additional nursing licenses as needed.

Responsibilities

• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care and coordinate utilization management.
• Identify opportunities to promote quality and effectiveness of services.
• Lend expertise to internal/external stakeholders in UM/CM functions.
• Meet productivity and quality expectations as set by UMNC.

Skills

Communication

Computer skills

Multitasking & prioritization

Sitting long periods

Education

Diploma RN

Associate degree or BSN preferred

Job description

CVS Health is hiring for a full-time, work-from-home Utilization Management Nurse. You will assess, plan, implement, and coordinate healthcare services for members using clinical criteria and collaboration with providers. A valid RN license in the state of residence is required.

The role emphasizes communication, multitasking, and adherence to UM/CM guidelines while ensuring quality outcomes. Weekend coverage is required, with a competitive benefits package and base pay range.