RN Utilization & Care Coordination Specialist

CVS Health; Nevada; Hybrid; USD 36,000 - 83,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a registered nurse to join a patient-centered care team supporting utilization management and benefits coordination for members. This full-time, remote role requires active RN licensure and at least 2 years in adult acute or critical care, with weekend/holiday availability.

You will assess, plan, coordinate, and communicate with providers to facilitate appropriate care, while navigating multiple systems securely.

Qualifications

• Active RN license in the state of residence.
• 2+ years of RN experience in adult acute/critical care.
• Ability to work weekends, holidays, and evenings as required by business needs.
• Residence in US time zones (CT, MT, or PT) for coverage considerations.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate healthcare services for members.
• Render coverage determinations/recommendations using clinical criteria and guidelines.
• Communicate with providers to facilitate care and promote appropriate utilization.
• Identify referral opportunities to integrate with other CVS Health products and programs.
• Collaborate with internal/external stakeholders to coordinate utilization management.
• Provide expertise in coordination and administration of utilization/benefit management.
• Maintain productivity and quality standards in a typical office setting.

Skills

Communication skills

Multitasking

Computer skills

Education

Associates Degree in Nursing or Nursing Diploma

Tools

Microsoft Office 365

HIPAA compliance

Job description

CVS Health is seeking a registered nurse to join a patient-centered care team supporting utilization management and benefits coordination for members. This full-time, remote role requires active RN licensure and at least 2 years in adult acute or critical care, with weekend/holiday availability.

You will assess, plan, coordinate, and communicate with providers to facilitate appropriate care, while navigating multiple systems securely.