Remote RN: Utilization Management & Care Coordination

4062 Aetna Resources, LLC; New York (NY); Hybrid; USD 67,000 - 143,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Job summary

CVS Health is seeking a Registered Nurse (RN) for Utilization Management to support 24/7 operations from a home-based setting. You will review cases, assess medical necessity, coordinate care, and help ensure members receive high-quality services.

You must have an active, unrestricted RN license, 2+ years of adult acute/critical care experience, and an Associate Degree in Nursing. BSN is preferred; strong communication and IT skills are essential.

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; BSN preferred.
• Strong communication, multitasking and computer navigation skills.

Responsibilities

• Review clinical information and apply criteria to support coverage determinations.
• Collaborate with providers, care teams and internal partners to coordinate treatment.
• Identify opportunities to improve healthcare quality, outcomes and benefit utilization.
• Refer members to programs and services to support health needs.
• Serve as a clinical resource for utilization and benefit management questions.

Skills

Communication

Multitasking

Computer navigation

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint)

Job description

CVS Health is seeking a Registered Nurse (RN) for Utilization Management to support 24/7 operations from a home-based setting. You will review cases, assess medical necessity, coordinate care, and help ensure members receive high-quality services.

You must have an active, unrestricted RN license, 2+ years of adult acute/critical care experience, and an Associate Degree in Nursing. BSN is preferred; strong communication and IT skills are essential.