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Nurse Reviewer (Registered Nurse) - Remote in US id-19077

Are you a Registered Nurse (RN) looking for an opportunity to make a meaningful impact while working from home? At CVS Health, we’re dedicated to improving patient outcomes and healthcare experiences. Join our team as a Nurse Reviewer and help ensure the quality and accuracy of clinical decisions through detailed case reviews and collaboration with healthcare professionals.

Responsibilities:

  • Conduct clinical reviews of medical records to determine medical necessity and compliance with coverage guidelines.
  • Work closely with healthcare providers to gather additional information and clarify clinical details.
  • Utilize established criteria, policies, and procedures to evaluate the appropriateness of care.
  • Provide clear and professional documentation of review findings.
  • Support case management and utilization management initiatives by identifying trends and improvement opportunities.
  • Collaborate with internal teams to enhance healthcare quality and efficiency.
  • Maintain confidentiality and adhere to all regulatory requirements.

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Requirements:

  • Active and unrestricted RN license in the United States.
  • Minimum of 3 years of clinical experience in acute care, case management, utilization review, or related fields.
  • Experience in medical necessity review or utilization management is preferred.
  • Strong analytical and critical thinking skills.
  • Ability to work independently in a remote setting while meeting deadlines.
  • Familiarity with insurance guidelines, medical terminology, and clinical policies.
  • Proficiency in using computers and medical review software.

Benefits:

  • Competitive salary with performance-based incentives.
  • Comprehensive health benefits (medical, dental, vision).
  • 401(k) retirement plan with company match.
  • Paid time off (PTO) and holidays.
  • Career development opportunities and tuition reimbursement.
  • Employee wellness programs and work-life balance support.

Why Join Us?

At CVS Health, we are more than just a healthcare company—we are a community dedicated to helping people on their path to better health. By joining our team, you will:
✔ Work remotely with flexible scheduling.
✔ Be part of a mission-driven organization that values innovation and collaboration.
✔ Gain access to continuous learning and career growth opportunities.
✔ Make a difference in healthcare by ensuring quality and compliance.

How to Apply

Ready to take the next step? Apply today by submitting your resume and application through our official CVS Health Careers page. We look forward to welcoming you to our team!

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When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

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