Remote Utilization Review Nurse

Job Summary

**Job Type**: Full-Time

**Salary**: Competitive, based on experience and qualifications

**Working Hours**: Standard full-time hours

**Company**: CVS Health

**Remote Location**: Nationwide (USA)

**Benefits**: Health, Dental, Vision, Paid Training, Paid Vacations, 401(k) with company match, Career development opportunities

Job Description

CVS Health is seeking a remote Utilization Review Nurse to join our dynamic healthcare team. This is a fantastic opportunity for a dedicated and experienced nursing professional to advance their career in a supportive and innovative environment while working from the comfort of their own home.

As a Utilization Review Nurse at CVS Health, you will be responsible for reviewing and monitoring patient medical records and healthcare services to ensure the appropriate use of resources and compliance with established guidelines. You will collaborate with healthcare providers, patients, and insurance companies to optimize patient outcomes and manage healthcare costs.

Requirements

1. Valid RN license in the state of residence.

2. Minimum of 3 years of clinical nursing experience.

3. Prior experience in utilization review, case management, or a similar role is preferred.

4. Strong analytical and critical thinking skills.

5. Excellent communication and interpersonal skills.

6. Proficiency in using electronic health records (EHR) and other healthcare software.

7. Ability to work independently and manage time effectively in a remote setting.

Responsibilities

1. Conduct utilization reviews of patient medical records to ensure appropriate care and resource utilization.

2. Collaborate with physicians, healthcare providers, and insurance companies to facilitate optimal patient care.

3. Provide clinical expertise and guidance on medical necessity, level of care, and treatment plans.

4. Ensure compliance with applicable laws, regulations, and accreditation standards.

5. Document review findings and decisions in the electronic health record system.

6. Participate in quality improvement initiatives and contribute to the development of review protocols.

7. Communicate review outcomes and provide education to healthcare providers and patients as necessary.

Benefits

– Comprehensive health, dental, and vision insurance

– Paid training and professional development opportunities

– Generous paid vacation and sick leave

– 401(k) plan with company match

– Flexible work schedule

– Employee discount programs

– Supportive and collaborative work environment

Educational Qualifications

– Bachelor? degree in Nursing (BSN) required.

– Advanced degree or certification in healthcare management, case management, or utilization review is a plus.

Experience

– A minimum of 3 years of clinical nursing experience is required.

– Previous experience in utilization review or a similar role is highly desirable.

Company Overview

CVS Health is a leading healthcare innovation company dedicated to helping people on their path to better health. With over 300,000 colleagues across the United States, we are committed to providing high-quality healthcare services and improving patient outcomes. Our comprehensive portfolio includes retail pharmacies, pharmacy benefit management services, and a growing number of medical clinics. At CVS Health, we believe in the power of collaboration and innovation to transform healthcare delivery and make a meaningful impact on the communities we serve.

Join us in our mission to improve the health and well-being of millions of Americans. Apply today to become a part of our dedicated and passionate team of healthcare professionals.

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