RN, Utilization Management & Care Coordination

Able Too Work; Arizona; Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Job summary

CVS Health is seeking an experienced Registered Nurse to join its Utilization Management team. The role focuses on ensuring appropriate care through evidence-based review and care coordination, while supporting coverage determinations and care planning.

You will collaborate with providers, apply guidelines, and identify opportunities for care management referrals in a dynamic, 24/7 environment with strong emphasis on patient outcomes and healthcare quality.

Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years of RN experience in an adult acute care or critical care setting.
• Strong communication, multitasking, and computer navigation skills.
• Ability to work a flexible schedule, including evenings, weekends, and holidays as part of a 24/7 operation.
• Associates Degree in Nursing required.
• 2+ years of Med-Surg or specialty clinical experience preferred.
• Managed Care and/or Utilization Management experience preferred.
• Candidates residing in CST/MST/PST locations preferred.
• BSN preferred.

Responsibilities

• 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.

Skills

RN license

Clinical communication

Care coordination

Time management

Computer skills

Education

Associates Degree in Nursing

BSN preferred

Job description

CVS Health is seeking an experienced Registered Nurse to join its Utilization Management team. The role focuses on ensuring appropriate care through evidence-based review and care coordination, while supporting coverage determinations and care planning.

You will collaborate with providers, apply guidelines, and identify opportunities for care management referrals in a dynamic, 24/7 environment with strong emphasis on patient outcomes and healthcare quality.