Role OverviewCVS Health is seeking a Utilization Management Nurse (RN) for a 24/7 operations team. This remote role involves reviewing clinical information and applying guidelines to make coverage determinations across the care continuum, collaborating with providers and internal teams to coordinate care and support treatment plans.
What You Will Do
Review clinical information and apply guidelines to make coverage determinations across the care continuum. Collaborate with providers and internal teams to coordinate care and support treatment plans. Identify opportunities to enhance quality, efficiency, and member outcomes. Refer members to appropriate programs, services, and resources. Serve as a clinical expert in utilization and benefit management.
Why It Might Be a Fit
This role requires an active, unrestricted RN license and 2+ years of recent experience in adult acute or critical care. Strong clinical judgment, communication, and multitasking skills are essential. The position offers a collaborative team environment and a comprehensive benefits package including medical, dental, vision coverage, paid time off, and retirement savings options.
Requirements
- Active, unrestricted RN license in your state of residence
- 2+ years of recent experience in adult acute or critical care
- Strong clinical judgment, communication, and multitasking skills
- Comfort working in a fast-paced, technology-driven environment
- Associates Degree in Nursing
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Bonus, commission or short-term incentive program
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