Remote Utilization Management RN | Clinical Care Liaison

CVS Health; Columbus (OH); Remote; USD 36,000 - 103,000; Full time

Job summary

CVS Health is seeking a Registered Nurse to join the Utilization Management team in a remote-capable role. You will assess and coordinate care, apply clinical criteria, and determine coverage for members while collaborating with providers and internal teams.

The position requires an active RN license, at least two years in adult acute or critical care, and the ability to work in a fast-paced, technology-driven environment.

Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years RN experience in adult acute care or critical care settings.
• BSN preferred or higher education credentials.

Responsibilities

• Assess, plan, coordinate, implement, and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Render coverage determinations/recommendations using clinical criteria and guidelines.
• Communicate with providers and other parties to coordinate care and identify referral opportunities.
• Support utilization management function through collaboration with internal/external stakeholders.
• Maintain proficiency with electronic systems and HIPAA-compliant processes.

Skills

Active RN license

2+ years acute/critical care

Education

Associate Degree in Nursing

BSN preferred

Job description

CVS Health is seeking a Registered Nurse to join the Utilization Management team in a remote-capable role. You will assess and coordinate care, apply clinical criteria, and determine coverage for members while collaborating with providers and internal teams.

The position requires an active RN license, at least two years in adult acute or critical care, and the ability to work in a fast-paced, technology-driven environment.