Remote RN: Utilization Management & Care Coordination

CVS Health; Nebraska; Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Paid Time Off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced Registered Nurse (RN) to join our Utilization Management team. The RN will review cases, support coverage determinations, coordinate care, and ensure members receive appropriate services across the continuum of care.

The role requires an active RN license, 2+ years of acute or critical care nursing, and strong communication and multitasking abilities. Schedule includes 24/7 operations with potential evenings, weekends, and holidays.

Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years of RN experience in an adult acute care or critical care setting.
• Strong communication, critical thinking, and multitasking skills.
• Proficiency navigating multiple computer systems.
• Associates Degree in Nursing Required.

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.

Skills

Active RN license

RN experience (2+)

Communication skills

Multitasking

Computer systems navigation

Education

Associate Degree in Nursing

BSN (Preferred)

Tools

EHR systems

Job description

CVS Health is seeking an experienced Registered Nurse (RN) to join our Utilization Management team. The RN will review cases, support coverage determinations, coordinate care, and ensure members receive appropriate services across the continuum of care.

The role requires an active RN license, 2+ years of acute or critical care nursing, and strong communication and multitasking abilities. Schedule includes 24/7 operations with potential evenings, weekends, and holidays.