Remote RN - Utilization Management Specialist

CVS Health; Des Moines (IA); Remote; USD 36,000 - 95,000; Full time

Job summary

CVS Health is seeking a Registered Nurse (RN) for Utilization Management. Join a collaborative team focused on ensuring members receive appropriate care through evidence-based reviews and care coordination.

Responsibilities include supporting coverage determinations, applying guidelines, and coordinating with providers to promote quality outcomes. Flexibility to work evenings, weekends, and holidays in a 24/7 operation is required.

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.
• BSN preferred.
• Strong communication, multitasking, and computer navigation skills.
• Ability to work a flexible schedule, including evenings, weekends, and holidays as part of a 24/7 operation.

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

Adult acute/critical care

Communication

Multitasking

Computer navigation

Education

Associates Degree in Nursing

BSN preferred

Tools

Microsoft Office 365

EHR portal

VPN

Job description

CVS Health is seeking a Registered Nurse (RN) for Utilization Management. Join a collaborative team focused on ensuring members receive appropriate care through evidence-based reviews and care coordination.

Responsibilities include supporting coverage determinations, applying guidelines, and coordinating with providers to promote quality outcomes. Flexibility to work evenings, weekends, and holidays in a 24/7 operation is required.