Remote RN Utilization Management Specialist

CVS Health; New Mexico; Hybrid; USD 36,000 - 95,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings

Wellness programs

Bonus eligibility

Job summary

CVS Health is hiring an experienced Registered Nurse (RN) for Utilization Management to ensure appropriate care in a dynamic, collaborative environment. You will review clinical information, apply guidelines, and coordinate with providers to support coverage decisions.

The role requires an active RN license, 2+ years in adult acute or critical care, 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

RN license

Acute/critical care

Communication

Multitasking

Computer navigation

Flexible schedule

Associates degree

Education

Associates Degree in Nursing

Tools

Microsoft Office 365

Teams

Outlook

Word

Excel

PowerPoint

Job description

CVS Health is hiring an experienced Registered Nurse (RN) for Utilization Management to ensure appropriate care in a dynamic, collaborative environment. You will review clinical information, apply guidelines, and coordinate with providers to support coverage decisions.

The role requires an active RN license, 2+ years in adult acute or critical care, and the ability to work a flexible schedule including evenings and weekends.