Remote RN Utilization Review Specialist

CVS Health Corporation; Mississippi; Hybrid; USD 54,000 - 117,000; Full time

Job summary

CVS Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically necessary care across the continuum. This role offers work-from-home scheduling, Monday–Friday, with some weekend coverage.

The ideal candidate holds an active Louisiana or Compact RN license, 5+ years inpatient nursing, and 2+ years in utilization management or discharge planning, with an Associate degree (BSN preferred).

Qualifications

• Active, unrestricted Louisiana or Compact RN license required.
• Must be willing to obtain additional state licenses as needed.
• 5+ years of inpatient clinical nursing experience.
• 2+ years of Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review experience.
• Associate's degree in nursing required. BSN preferred.

Responsibilities

• Review clinical information and apply medical necessity criteria and clinical judgment to coverage recommendations.
• Collaborate with providers and internal teams to coordinate appropriate care and discharge planning.
• Identify opportunities for care management referrals and improved healthcare utilization.
• Support timely, effective care for members across the continuum.

Skills

Inpatient nursing experience

Utilization management experience

Discharge planning

Provider communication

Education

Associate degree in nursing

BSN preferred

Tools

Microsoft 365 proficiency

Job description

CVS Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically necessary care across the continuum. This role offers work-from-home scheduling, Monday–Friday, with some weekend coverage.

The ideal candidate holds an active Louisiana or Compact RN license, 5+ years inpatient nursing, and 2+ years in utilization management or discharge planning, with an Associate degree (BSN preferred).