Remote RN: Utilization Management & Care Coordination

4062 Aetna Resources, LLC; United States; Remote; USD 91,722,000 - 196,424,000; Full time

Job summary

CVS Health is seeking an experienced Registered Nurse to support 24/7 Utilization Management, reviewing cases, assessing medical necessity, and coordinating care from a remote home office. Candidates must hold an active RN license and have at least 2 years of acute or critical care experience.

Responsibilities include applying criteria for coverage determinations, collaborating with providers and teams, and guiding members to appropriate programs.

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.
• Strong communication, multitasking, and computer navigation skills.
• Ability to work a designated schedule of 8:00 am to 5:00 PM ET, including weekends, holidays, and evening hours based on business needs.

Responsibilities

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

Skills

RN license

2+ years acute/critical care

Education

Associate Degree in Nursing

Tools

Microsoft Office 365

EHR system

Job description

CVS Health is seeking an experienced Registered Nurse to support 24/7 Utilization Management, reviewing cases, assessing medical necessity, and coordinating care from a remote home office. Candidates must hold an active RN license and have at least 2 years of acute or critical care experience.

Responsibilities include applying criteria for coverage determinations, collaborating with providers and teams, and guiding members to appropriate programs.