Remote RN Utilization Management & Care Coordination

CVS Health; Hartford (CT); Hybrid; USD 91,722,000 - 196,424,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Hartford, CT is seeking a Registered Nurse (RN) for Utilization Management to apply evidence-based guidelines and help ensure members receive the right care at the right time. The role collaborates with providers and care teams to coordinate services, support the continuum of care, and act as a clinical resource for utilization and benefit management.

Requires at least 2 years in adult acute or critical care, an active RN license, and readiness for a hybrid, full-time schedule with

Qualifications

• Active, unrestricted RN license in state of residence.
• Minimum 2 years of RN experience in adult acute care or critical care.
• Strong clinical judgment, communication, and organizational skills.
• Ability to work in a fast-paced environment while navigating multiple systems.

Responsibilities

• Review clinical information and apply evidence-based guidelines to support coverage and care decisions.
• Collaborate with providers, care teams, and internal partners to coordinate appropriate healthcare services.
• Identify opportunities to improve care quality, outcomes, and benefit utilization.
• Support members through the continuum of care by connecting them to relevant programs and resources.
• Serve as a clinical resource for utilization and benefit management activities.

Skills

RN license

Clinical judgment

Communication

Organizational skills

Multi-system navigation

Education

Associate’s Degree in Nursing

BSN preferred

Tools

Microsoft Office 365

EHR systems

VPN

Job description

CVS Health in Hartford, CT is seeking a Registered Nurse (RN) for Utilization Management to apply evidence-based guidelines and help ensure members receive the right care at the right time. The role collaborates with providers and care teams to coordinate services, support the continuum of care, and act as a clinical resource for utilization and benefit management.

Requires at least 2 years in adult acute or critical care, an active RN license, and readiness for a hybrid, full-time schedule with