Remote RN: Utilization Management Specialist

CVS Health; Trenton (NJ); Remote; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical benefits

Dental

Vision

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking an RN in New Jersey to support Utilization Management. The role involves assessing and coordinating care, applying clinical criteria for coverage decisions, and collaborating with providers and teams.

The position requires active RN licensure, 2+ years of acute/critical care experience, and willingness to work a 24/7 schedule including weekends and evenings. Associates degree is required; BSN preferred.

Qualifications

• Active RN licensure in state of residence.
• 2+ years RN experience in adult acute/critical care.
• Familiarity with Utilization Management processes.
• Willing to work a 24/7 schedule including weekends and evenings.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate care options for members.
• Apply clinical criteria and guidelines to render coverage determinations.
• Communicate with providers to facilitate care and referral opportunities.
• Collaborate with internal/external teams in utilization/benefit management.

Skills

RN license

Clinical experience

Utilization Management

Flexible schedule

Education

Associates Degree

BSN preferred

Tools

Microsoft Office

EMR/EHR systems

Job description

CVS Health is seeking an RN in New Jersey to support Utilization Management. The role involves assessing and coordinating care, applying clinical criteria for coverage decisions, and collaborating with providers and teams.

The position requires active RN licensure, 2+ years of acute/critical care experience, and willingness to work a 24/7 schedule including weekends and evenings. Associates degree is required; BSN preferred.