Remote RN Utilization Management Specialist

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

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health in Minnesota is seeking an experienced Registered Nurse for Utilization Management to assess, plan, coordinate and monitor care and benefits for members. You will render coverage determinations using clinical criteria, consult with providers, and collaborate with internal teams to optimize healthcare services while maintaining high quality and compliance.

This full-time remote role requires active RN licensure, 2+ years in adult acute/critical care, ability to work weekends/evenings,

Qualifications

• Active RN license in the state of residence.
• 2+ years RN experience in adult acute/critical care.
• Must be available for weekends, holidays and evenings as required.
• Reside in Central/Mountain/Pacific time zones.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate care and benefits for members.
• Render coverage determinations using clinical criteria and guidelines.
• Communicate with providers to facilitate care and treatment.
• Identify referral opportunities to integrate with programs and services.
• Collaborate with internal teams to promote quality and utilization management.

Skills

Clinical nursing

RN licensure

Multitasking

Communication

Education

Associate degree in Nursing

Tools

Office 365

Job description

CVS Health in Minnesota is seeking an experienced Registered Nurse for Utilization Management to assess, plan, coordinate and monitor care and benefits for members. You will render coverage determinations using clinical criteria, consult with providers, and collaborate with internal teams to optimize healthcare services while maintaining high quality and compliance.

This full-time remote role requires active RN licensure, 2+ years in adult acute/critical care, ability to work weekends/evenings,