Remote RN: Utilization Management & Care Coordination

CVS Health; Pennsylvania; Hybrid; USD 40,000 - 86,000; Full time

Benefits offered by this job

Benefits package

Work-from-home eligible

Job summary

CVS Health is seeking a Registered Nurse for Utilization Management to assess, plan, coordinate, and evaluate options to facilitate appropriate healthcare services for members. The role requires applying clinical criteria and interfacing with providers to ensure optimal benefit utilization.

The position supports a 40-hour workweek, with a 24/7 operation and weekends/evenings. Remote work within the live state may apply, with a comprehensive benefits package and bonus eligibility.

Qualifications

• 2+ years of RN experience in adult acute/critical care
• Active RN license in state of residence
• Utilization Management experience preferred

Responsibilities

• Assess, plan, implement and evaluate options to facilitate appropriate health care services for members.
• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care.
• Identify members for referral opportunities and integration with programs.
• Promote quality and effectiveness of healthcare services and benefit utilization.
• Collaborate with internal/external constituents in utilization/benefit management.

Skills

RN experience

Active RN license

Healthcare coordination

Education

Associates Degree

BSN preferred

Tools

Office 365

EHR systems

VPN security

Job description

CVS Health is seeking a Registered Nurse for Utilization Management to assess, plan, coordinate, and evaluate options to facilitate appropriate healthcare services for members. The role requires applying clinical criteria and interfacing with providers to ensure optimal benefit utilization.

The position supports a 40-hour workweek, with a 24/7 operation and weekends/evenings. Remote work within the live state may apply, with a comprehensive benefits package and bonus eligibility.