# Utilization Management Registered Nurse

**Company**: CVS Health
**Work arrangement**: remote
**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/Work-At-Home-Oregon/Utilization-Management-Nurse-Consultant_R1089346?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/utilization-management-registered-nurse-1b8d3168-00c/

## Description

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

**Position Summary**

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

- 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.

- Typical office working environment with productivity and quality expectations.

- Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.

- Sedentary work involving periods of sitting, talking, listening.

- Work requires sitting for extended periods, talking on the telephone, and typing on the computer.

- Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment.

- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

- Effective communication skills, both verbal and written.

**Required Qualifications**

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

- Must have active current and unrestricted RN licensure in the state of residence.

**Preferred Qualifications**

- 2+ years of clinical experience required in med surg or specialty area.

- Managed Care experience preferred, especially Utilization Management.

- Preference for those residing in PST zones.

**Education**

- Associate's Degree required.

- BSN preferred.

**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.

**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.

- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

- The company will provide equipment (keyboard, monitor, computer, headset, etc.).

**Anticipated Weekly Hours**

- 40

**Time Type**

- Full-time

**Pay Range**

- $29.10 - $62.32

**Benefits**

- Medical, dental, and vision coverage.

- Paid time off.

- Retirement savings options.

- Wellness programs.

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## Skills

### Required
- RN licensure
- clinical experience
- computer skills
- communication skills

### Nice to have
- Managed Care experience
- Utilization Management experience

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/Work-At-Home-Oregon/Utilization-Management-Nurse-Consultant_R1089346?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)