Remote RN — Utilization Management Specialist

Native American Talent; Arizona; Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is hiring an experienced Registered Nurse (RN) for Utilization Management to ensure appropriate care at the right time through evidence-based review and coordination. This role supports 24/7 operations and may require evenings, weekends, and holidays from a home-based setup.

Qualified candidates will have an active RN license, 2+ years in acute or critical care, and an Associate Degree in Nursing. BSN preferred; healthcare experience with managed care and utilization review is a plus.

Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years of RN experience in an adult acute care or critical care setting.
• Associates Degree in Nursing required.

Responsibilities

• Review and assess clinical information to support coverage determinations and care recommendations.
• Apply clinical guidelines, policies, and professional judgment across the continuum of care.
• Collaborate with providers and healthcare teams to facilitate quality patient outcomes.
• Identify opportunities for care management referrals and member support programs.
• Promote effective healthcare utilization and quality improvement initiatives.

Skills

RN license

Clinical review

Care coordination

Strong communication

Computer skills

Education

Associate Degree in Nursing

Tools

Microsoft Office 365

EHR portal

Job description

CVS Health is hiring an experienced Registered Nurse (RN) for Utilization Management to ensure appropriate care at the right time through evidence-based review and coordination. This role supports 24/7 operations and may require evenings, weekends, and holidays from a home-based setup.

Qualified candidates will have an active RN license, 2+ years in acute or critical care, and an Associate Degree in Nursing. BSN preferred; healthcare experience with managed care and utilization review is a plus.