# Utilization Management Registered Nurse

**Company**: CVS Health
**Location**: Work from home, PA, PA
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $29.10 - $62.32
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/PA---Work-from-home/Utilization-Management-Nurse-Consultant---Work-at-Home---EST_R1087767-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_097c5fc0-e7d

## Description

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.

**Job Summary**

Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

**Responsibilities**

- Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.

- Communicates with providers and other parties to facilitate care/treatment.

- Identifies members for referral opportunities to integrate with other products, services and/or programs.

- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.

- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

**Requirements**

- 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.

- Active current and unrestricted RN licensure in state of residence.

- Proficiency with computer skills which includes navigating multiple systems and keyboarding.

- Effective communication skills, both verbal and written.

**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.

**Work from Home Requirements**

- You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 50 Mbps download and 5 Mbps upload.

- A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.

**Benefits**

- Medical, dental, and vision coverage.

- Paid time off.

- Retirement savings options.

- Wellness programs.

## Skills

### Required
- Registered Nurse
- clinical experience
- computer skills
- communication skills

### Nice to have
- Managed Care experience
- Utilization Management experience
- med surg or specialty area experience

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/PA---Work-from-home/Utilization-Management-Nurse-Consultant---Work-at-Home---EST_R1087767-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)