RN Utilization Management Specialist

CVS Health; Athens (GA); Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Job summary

CVS Health is seeking a Registered Nurse to support utilization management and care coordination. You will assess plans, coordinate services, and render coverage determinations while collaborating with providers and care teams.

Ideal candidates hold an RN license with 2+ years in acute/critical care, and can work weekends/evenings. A strong emphasis on HIPAA guidelines and secure, quiet home office setup will be expected for remote work.

Qualifications

• Active RN license in state of residence.
• 2+ years of RN experience in adult acute/critical care.
• Must be available to work weekends, holidays, and evenings as required.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate healthcare services/benefits.
• Gathers clinical information and applies criteria to render coverage determinations/recommendations.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies referral opportunities to integrate with other programs.
• Promotes quality and effectiveness of healthcare services and utilization.
• Consults with internal and external constituents in utilization/benefit management.
• Work environment involves seated, typing and multi-tasking in a fast-paced setting.

Skills

Clinical assessment

Communication skills

Care coordination

Education

Associates Degree in Nursing

Bachelors Degree in Nursing

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Registered Nurse to support utilization management and care coordination. You will assess plans, coordinate services, and render coverage determinations while collaborating with providers and care teams.

Ideal candidates hold an RN license with 2+ years in acute/critical care, and can work weekends/evenings. A strong emphasis on HIPAA guidelines and secure, quiet home office setup will be expected for remote work.