Remote RN - Utilization Management Specialist

CVS Health

Alabama

Hybrid

USD 67,000 - 143,000

Full time

2 days ago

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Benefits offered by this job

Medical, dental and vision benefits

Bonus program

Job summary

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

Must hold an active RN license in your state, with 2+ years in adult acute or critical care, and an Associate Degree in Nursing. Typical hours are 8:00 am–5:00 PM ET, with weekends/holidays and evening hours as needed; remote, home-based work is supported

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.

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.