# Utilization Management Registered Nurse **Company**: CVS Health **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/OH---Work-from-hom/Utilization-Management-Nurse-Consultant--Remote--EST-CST-_R1093264?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/job/utilization-management-registered-nurse-0edcabd4-55c/ ## 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, and prioritize safety and quality in everything we do. **Position Summary** Utilization Management is a 24/7 operation, and work schedules will include weekends, holidays, and evening hours (approximately 12 weekend days/year, one evening shift/month, and 1 major and 1 minor holiday/year). As a Utilization Management Registered Nurse, you will utilize 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. Your responsibilities will include: - Gathering clinical information and applying clinical criteria/guidelines, policies, procedures, and clinical judgment to render coverage determinations/recommendations along the continuum of care - Communicating with providers and other parties to facilitate care/treatment - Identifying members for referral opportunities to integrate with other products, services, and programs - Identifying opportunities to promote quality effectiveness of Healthcare Services and benefit utilization - Consulting and lending 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 an adult acute care/critical care setting - Active current and unrestricted RN licensure in the state of residence - Proficiency with computer skills, including 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, such as restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues **Work from Home Requirements** - 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 - Commitment to obtaining required internet speeds and adhering to all Work From Home requirements **Preferred Qualifications** - 2+ years of clinical experience in med-surg or specialty area - Managed Care experience, especially Utilization Management - Preference for those residing in EST zones **Education** - Associate's degree required - BSN preferred **Anticipated Weekly Hours** - 40 **Time Type** - Full-time **Pay Range** - $29.10 - $62.32 **Benefits** - Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources For more fresh new jobs, check out [yubhub.co](https://yubhub.co/). ## Skills ### Required - RN licensure - clinical experience - computer skills - communication skills ### Nice to have - managed care experience - utilization management experience --- Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/OH---Work-from-hom/Utilization-Management-Nurse-Consultant--Remote--EST-CST-_R1093264?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)