Remote RN Utilization Management Specialist

CVS Health; South Carolina; Hybrid; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking an experienced Registered Nurse to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services for members. You will apply clinical criteria and guidelines to render coverage determinations and work closely with providers to ensure optimal patient care.

The role requires an active RN license, an Associate degree in Nursing (Bachelor's preferred), and at least 2 years in adult acute or critical care.

Qualifications

• Associates Degree in Nursing all required; Bachelor's Degree preferred.
• Active and unrestricted RN license in state of residence.
• 2+ years of RN experience in adult acute/critical care setting.
• Availability to work weekends, holidays, and evenings as required by business needs.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Apply clinical criteria/guidelines, policies and clinical judgment to render coverage determinations/recommendations.
• Communicate with providers and other parties to facilitate care and identify referral opportunities.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Collaborate with internal and external constituents in utilization/benefit management.

Education

Associates Degree in Nursing

Bachelor's Degree in Nursing

RN license

Job description

CVS Health is seeking an experienced Registered Nurse to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services for members. You will apply clinical criteria and guidelines to render coverage determinations and work closely with providers to ensure optimal patient care.

The role requires an active RN license, an Associate degree in Nursing (Bachelor's preferred), and at least 2 years in adult acute or critical care.