Remote RN | Utilization Management Specialist

CVS Health; Ohio; Hybrid; USD 40,000 - 86,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Job summary

CVS Health is seeking an experienced Registered Nurse to join our Utilization Management team in a remote capacity. The role focuses on ensuring members receive appropriate, high-quality services across the continuum of care.

The ideal candidate will have an unrestricted RN license, 2+ years in adult acute or critical care, and experience in managed care/utilization management. A BSN is preferred and a strong workflow with HIPAA compliance is required.

Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years of RN experience in adult acute care or critical care settings.
• 2+ years of Managed Care and/or Utilization Management experience
• Education Associate Degree in Nursing required; BSN preferred.

Responsibilities

• Utilizes clinical experience to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members.
• Gathers clinical information and applies guidelines and clinical judgment to render coverage determinations/recommendations.
• Communicates with providers and other parties to facilitate care and treatment.
• Identifies members for referral opportunities to integrate with other products and services.
• Identifies opportunities to promote quality and effectiveness of healthcare services and utilization.
• Coordinates with internal and external stakeholders in utilization/benefits management.

Skills

RN license

Clinical assessment

Utilization management

Communication

Multitasking

Tech-savvy

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is seeking an experienced Registered Nurse to join our Utilization Management team in a remote capacity. The role focuses on ensuring members receive appropriate, high-quality services across the continuum of care.

The ideal candidate will have an unrestricted RN license, 2+ years in adult acute or critical care, and experience in managed care/utilization management. A BSN is preferred and a strong workflow with HIPAA compliance is required.