Remote Hybrid Quality Nurse RN, IL

CVS Health

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IL – Work from home
Full time
Posted Today

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.




These role requires 25% to 35% for audit reviews, as needed. Position can be remote from any US location


Hours for these positions are Monday-Friday 8:00a-5:30p EST.

Position Summary

  • Responsible for ongoing assistance with file preparation and presentation of UM elements for audits.
  •  Participates in the development and ongoing implementation of quality improvement activities.
  • Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM clinical objectives. Responsible for the review and evaluation of clinical information and documentation to assess accuracy in the clinical appeals.
  • Review documentation and interprets data obtained from clinical records or systems to provide coaching.
  • Interprets relevant clinical criteria and/or medical policies/benefits.

Required Qualifications

  • 3+ years Utilization Management experience
  • 3+ years of Clinical experience
  • Must have active and unrestricted RN licensure in state of residence
  • Ability to travel 25% to 35% for audit reviews, as needed.
  • Ability to work 8 :00 AM – 4:30 PM EST

Preferred Qualifications

  • QuickBase experience a plus
  • Microsoft Office experience
  • 2+ years of experience with regulatory and accreditation requirements, clinical criteria, benefit plan and/or contractual arrangements.



  • Associates degree required; BSN preferred



Pay Range

The typical pay range for this role is:


$60,522.80 – $129,600.00


This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  

For more detailed information on available benefits, please visit




CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.