Remote Prior Authorization Clinical Reviewer / RN - Transform Healthcare with CVS Health

Join our innovative team as a Prior Authorization Clinical Reviewer / RN and play a vital role in shaping the future of healthcare! We're seeking a highly skilled and compassionate RN to work remotely and collaborate with our team to deliver exceptional patient care. As a key member of our team, you will utilize your clinical expertise to review prior authorizations, coordinate care, and communicate with providers and patients. This is a full-time, remote opportunity with a competitive salary range of $29.10 - $62.31 per hour, plus eligibility for a CVS Health bonus, commission, or short-term incentive program.

At CVS Health, we're committed to bringing our heart to every moment of our patients' healthcare journeys. Our purpose is to deliver human-centric healthcare that is personal, convenient, and affordable. As a Prior Authorization Clinical Reviewer / RN, you will be instrumental in helping us achieve this mission. You will work closely with our team to review prior authorizations, apply medical necessity criteria, and facilitate care management programs. Your strong clinical skills, critical thinking, and excellent communication skills will enable you to make a meaningful impact on our patients' lives.

Key Responsibilities

• Conduct prior authorization reviews for physical and behavioral health services
• Utilize clinical skills to coordinate, document, and communicate care plans
• Apply critical thinking and knowledge of evidence-based care to determine medical necessity
• Communicate with providers and patients to address prior authorization questions and concerns
• Identify opportunities to promote quality and effectiveness of healthcare services

Requirements

• 5+ years of clinical experience as an RN
• Active and unrestricted RN licensure in the state of Arizona
• Residence in the MST (AZ) time zone
• Willingness to travel for in-state meetings on rare occasions
• Reliable transportation and reimbursement for mileage

Preferred Qualifications

• Prior utilization management experience
• Strong critical thinking and written communication skills
• Bachelor's Degree in Nursing

What We Offer

• Competitive salary range of $29.10 - $62.31 per hour
• Eligibility for a CVS Health bonus, commission, or short-term incentive program
• Comprehensive benefits package, including medical, dental, and vision coverage
• 401(k) retirement savings plan and Employee Stock Purchase Plan
• Paid Time Off (PTO) and paid holidays
• Opportunities for professional growth and development

How to Apply

If you're a motivated and compassionate RN looking to make a difference in healthcare, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and a cover letter, to be considered for this role.

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Your Future Starts Here

Don't miss out on this opportunity to join our team and transform healthcare with CVS Health. Apply now and take the first step towards a rewarding and challenging career!