Remote RN Utilization Management Specialist

CVS Health Corporation; Montgomery (AL); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, vision

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking an experienced Registered Nurse (RN) for Utilization Management to support 24/7 operations from a remote work setup. Review cases, assess medical necessity, coordinate care and ensure high-quality services for members.

Required RN license, 2+ years in adult acute/critical care, ADN, and strong communication. Weekend/evening availability may be needed; BSN preferred. Benefits and flexibility included.

Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years of RN experience in adult acute or critical care.
• Strong communication, multitasking, and computer navigation skills.
• Ability to work 8:00 am–5:00 PM ET, including weekends, holidays, and evening hours.

Responsibilities

• Review clinical information and apply evidence-based criteria to support coverage determinations and care recommendations.
• Collaborate with providers, care teams, and internal partners to coordinate treatment and services.
• Identify opportunities to improve healthcare quality, outcomes, and benefit utilization.
• Refer members to programs and services that support overall health needs.
• Serve as a clinical resource for utilization and benefit management questions.

Skills

RN license

Acute/critical care

Communication

Schedule flexibility

Education

Associate Degree in Nursing

BSN preferred

Job description

CVS Health Corporation is seeking an experienced Registered Nurse (RN) for Utilization Management to support 24/7 operations from a remote work setup. Review cases, assess medical necessity, coordinate care and ensure high-quality services for members.

Required RN license, 2+ years in adult acute/critical care, ADN, and strong communication. Weekend/evening availability may be needed; BSN preferred. Benefits and flexibility included.