Remote RN – Utilization Management Specialist

CVS Health; Idaho; Hybrid; USD 36,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus potential

Job summary

CVS Health is seeking a Registered Nurse (RN) for Utilization Management to ensure appropriate care delivery and coordinate patient care with clinical teams. The role emphasizes evidence-based review, care coordination, and collaboration with providers to optimize outcomes.

This full-time position requires an active RN license, 2+ years of relevant experience, and the ability to work a flexible schedule including evenings and weekends.

Qualifications

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

Communication skills

Multitasking

Computer navigation

Flexible schedule

Education

Associates Degree in Nursing

Job description

CVS Health is seeking a Registered Nurse (RN) for Utilization Management to ensure appropriate care delivery and coordinate patient care with clinical teams. The role emphasizes evidence-based review, care coordination, and collaboration with providers to optimize outcomes.

This full-time position requires an active RN license, 2+ years of relevant experience, and the ability to work a flexible schedule including evenings and weekends.