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Remote Cvs Utilization Management Nurse Jobs in Florida

Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Active Registered Nurse (RN) license required. (Not encumbered only) * Florida State-required RN ...

Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Active Registered Nurse (RN) license required. (Not encumbered only) * Florida State-required RN ...

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Remote Cvs Utilization Management Nurse information

What is the difference between Remote Cvs Utilization Management Nurse vs Remote Cvs Case Manager?

AspectRemote Cvs Utilization Management NurseRemote Cvs Case Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification
Work EnvironmentUtilization review teams, insurance companiesPatient advocacy, care coordination teams
Employer & IndustryHealth insurance, managed care organizationsHealth insurance, healthcare providers

Both roles require RN licensure and related certifications, but the Utilization Management Nurse focuses on reviewing medical necessity and approving services, while the Case Manager emphasizes coordinating patient care and discharge planning. Understanding these differences helps job seekers find the right fit within the healthcare and insurance industries.

What are the most commonly searched types of Cvs Utilization Management Nurse jobs in Florida?

The most popular types of Cvs Utilization Management Nurse jobs in Florida are:

What cities in Florida are hiring for Remote Cvs Utilization Management Nurse jobs?

Cities in Florida with the most Remote Cvs Utilization Management Nurse job openings:

Infographic showing various Remote Cvs Utilization Management Nurse job openings in Florida as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 11% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

Utilization Review RN (Remote)

HealthPlus Staffing

Fort Lauderdale, FL • Remote

$80K - $100K/yr

Full-time

Re-posted 21 days ago


Job description

Quick Job Details:

Setting: Fully Remote – Utilization Review
Schedule: Full-Time, Monday–Friday
Hours: Standard business hours
Patient Volume: N/A
Job Requirements:

  • Active RN license with Multi-State/Compact license required
  • Minimum 2 years of Utilization Review experience
  • Minimum 3 years of clinical nursing experience (acute care/hospital preferred)
  • Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
  • Excellent communication, analytical, and critical thinking skills
  • Ability to work independently in a remote environment

Responsibilities:

  • Conduct admission, continued stay, and observation reviews
  • Apply medical necessity criteria to determine appropriate level of care
  • Review cases for Physician Advisor escalation when appropriate
  • Collaborate with physicians, case managers, and insurance payers
  • Support denial prevention, documentation improvement, and revenue cycle initiatives
  • Ensure compliance with payer guidelines and regulatory requirements
  • Analyze clinical and financial data to identify quality improvement opportunities

Compensation: Competitive; based on experience

Benefits: Comprehensive benefits package

About Us:

HealthPlus Staffing is a national leader in the healthcare staffing industry. We partner with top healthcare organizations nationwide to connect highly qualified professionals with outstanding career opportunities.

Our Promise:

  • We will put you in front of the decision makers.
  • We will provide feedback on your application.
  • We will work on your behalf to obtain as much information as possible to help you make a well-informed decision.

If you're interested in this opportunity, please submit an application or call 561-291-7787 to speak with one of our experienced consultants. We look forward to helping you find your next opportunity!

The HealthPlus Team