Remote RN - Utilization Management Specialist

CVS Health; Wyoming; Ibrido; USD 36.000 - 94.000; Tempo pieno

Descrizione del lavoro

CVS Health in the United States is seeking a Registered Nurse (RN) to join our Utilization Management team. You will help ensure members receive the right care at the right time through evidence-based clinical review and care coordination.

The role involves reviewing clinical information to support coverage determinations, applying guidelines, collaborating with providers, and promoting quality improvement in a 24/7 operation.

Competenze

• Active, unrestricted RN license.
• 2+ years RN experience in adult acute/critical care.
• Strong communication, multitasking, and computer navigation skills.
• Ability to work evenings, weekends and holidays in a 24/7 operation.
• Associates Degree in Nursing is required.

Mansioni

• 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.

Conoscenze

Active RN license

RN experience (2+ years)

Strong communication skills

Multitasking abilities

Computer navigation skills

Flexible schedule (nights, weekends, 1

Formazione

Associate Degree in Nursing

Descrizione del lavoro

CVS Health in the United States is seeking a Registered Nurse (RN) to join our Utilization Management team. You will help ensure members receive the right care at the right time through evidence-based clinical review and care coordination.

The role involves reviewing clinical information to support coverage determinations, applying guidelines, collaborating with providers, and promoting quality improvement in a 24/7 operation.