Remote RN: Utilization Management Specialist

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

Benefits offered by this job

Medical insurance

Dental and vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking a licensed RN to assess, plan, and coordinate healthcare services and benefits for members. You will apply clinical criteria and collaborate with providers to render coverage determinations and coordinate referrals across care settings.

The role emphasizes quality, efficiency, HIPAA compliance, and strong communication while supporting a flexible, remote-friendly work environment with defined hours.

Qualifications

• Active RN license in the state of residence.
• Associates Degree in Nursing or Nursing Diploma.
• 2+ years of RN experience in adult acute/critical care.
• Ability to work weekends, holidays, and evenings as needed.
• Proficiency with computer systems and documentation.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services/benefits.
• Gather clinical data and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care and coordinate referrals.
• Identify opportunities to promote quality, efficiency and utilization management.
• Consult internal/external stakeholders in utilization/benefit management.

Skills

RN licensure

Clinical nursing

Weekend availability

Communication skills

Education

Associates Degree in Nursing

RN license

Job description

CVS Health is seeking a licensed RN to assess, plan, and coordinate healthcare services and benefits for members. You will apply clinical criteria and collaborate with providers to render coverage determinations and coordinate referrals across care settings.

The role emphasizes quality, efficiency, HIPAA compliance, and strong communication while supporting a flexible, remote-friendly work environment with defined hours.