Remote RN: Utilization Management & Care Coordination

CVS Health; Topeka (KS); Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

CVS Health is seeking a registered nurse to join our Utilization Management team in a remote capacity. You will review clinical information, apply evidence-based criteria, and collaborate with providers to ensure members receive appropriate, high-quality care and benefits.

The role requires an active RN license, ADN, and at least two years in adult acute or critical care. You’ll work 40 hours weekly with a 24/7 operation and a comprehensive benefits package.

Qualifications

• Active, unrestricted RN license in your state of residence.
• Minimum 2 years RN experience in an adult acute care or critical care setting.
• Associate Degree in Nursing (ADN).
• Strong communication, multitasking, and computer skills.

Responsibilities

• Review clinical information to support coverage determinations and care coordination.
• Apply guidelines, policies, and professional judgment to utilization management decisions.
• Collaborate with providers and interdisciplinary teams to ensure appropriate services.
• Identify opportunities for care management referrals and member support programs.
• Promote quality, cost-effective healthcare delivery and benefit utilization.

Skills

RN license

2+ years RN experience

Communication skills

Multitasking

Computer skills

ADN

Education

ADN

BSN (preferred)

Tools

Microsoft Office 365

EHR system

Job description

CVS Health is seeking a registered nurse to join our Utilization Management team in a remote capacity. You will review clinical information, apply evidence-based criteria, and collaborate with providers to ensure members receive appropriate, high-quality care and benefits.

The role requires an active RN license, ADN, and at least two years in adult acute or critical care. You’ll work 40 hours weekly with a 24/7 operation and a comprehensive benefits package.