Remote RN Utilization Management Specialist

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

Benefits offered by this job

Bonus eligible

Job summary

CVS Health is hiring a Registered Nurse (RN) for Utilization Management to help ensure members receive appropriate care at the right time through evidence-based review and care coordination. This remote role supports a 24/7 operation and requires an active RN license and experience in acute or critical care.

You will review clinical information, apply guidelines, collaborate with providers, identify care management opportunities, and promote utilization and quality improvements.

Qualifications

• Active, unrestricted RN license in your state of residence.
• At least 2 years of RN experience in an adult acute care or critical care setting.
• Excellent communication, multitasking, and computer navigation skills.
• Able to work a flexible schedule including evenings, weekends, and holidays.
• 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

2+ years RN experience

Communication skills

Computer navigation

Flexible schedule

Education

Associate Degree in Nursing

Tools

Microsoft Office 365

EHR systems

Job description

CVS Health is hiring a Registered Nurse (RN) for Utilization Management to help ensure members receive appropriate care at the right time through evidence-based review and care coordination. This remote role supports a 24/7 operation and requires an active RN license and experience in acute or critical care.

You will review clinical information, apply guidelines, collaborate with providers, identify care management opportunities, and promote utilization and quality improvements.