Utilization Management Registered Nurse (RN) - Remote

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

At CVS Health, you'll be surrounded by colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.

Utilization Management Registered Nurse (RN) - Remote

Make a meaningful impact on patient care from wherever you work. We are seeking an experienced Registered Nurse (RN) to join our Utilization Management team, where you'll use your clinical expertise to help ensure members receive appropriate, high-quality healthcare services and benefits.

Responsibilities

• Review and assess clinical information to support coverage determinations and recommendations.
• Apply evidence-based clinical criteria, policies, and professional judgment across the continuum of care.
• Collaborate with providers and interdisciplinary teams to coordinate care and promote positive member outcomes.
• Identify opportunities for quality improvement, care integration, and effective benefit utilization.
• Serve as a clinical resource for internal and external stakeholders.

Requirements

• Active, unrestricted RN license in your state of residence.
• Minimum 2 years of RN experience in an adult acute care or critical care setting.
• Associates degree in nursing.

Preferred Qualifications

• 2+ years of Med-Surg or specialty clinical experience.
• Utilization Management and/or Managed Care experience.
• Strong communication, critical thinking, and computer navigation skills.
• Ability to thrive in a fast-paced environment and manage multiple priorities.
• Candidates located in the Eastern Time Zone are strongly preferred.
• BSN preferred.

Schedule

This is a 24/7 operation, and schedules may include evenings, weekends, and holidays.

Benefits

• Work remotely while leveraging your clinical expertise.
• Collaborate with a dedicated healthcare team.
• Influence quality outcomes and healthcare resource utilization.
• Build your career within a growing and impactful specialty area.

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$26.01 - $74.78