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.
We're seeking an experienced Registered Nurse (RN) to join our Utilization Management team. In this role, you'll use your clinical expertise to review cases, support coverage determinations, coordinate care, and ensure members receive appropriate healthcare services across the continuum of care.
Responsibilities
- Review clinical information and apply evidence-based criteria to make utilization and coverage recommendations.
- Collaborate with providers and healthcare teams to support appropriate treatment plans and care coordination.
- Identify opportunities to improve healthcare quality, outcomes, and benefit utilization.
- Refer members to additional programs and services that support their healthcare needs.
- Serve as a clinical resource for internal and external stakeholders.
Requirements
- Active, unrestricted RN license in your state of residence.
- 2+ years of RN experience in an adult acute care or critical care setting.
- Strong communication, critical thinking, and multitasking skills.
- Proficiency navigating multiple computer systems.
- Associates Degree in Nursing Required.
Preferred Qualifications
- 2+ years of Med-Surg or specialty clinical experience.
- Managed Care and/or Utilization Management experience.
- Candidates residing in the Central or Eastern time zones.
- BSN Preferred
Schedule This is a 24/7 operation, and schedules may include evenings, weekends, and holidays.
Benefits Join a collaborative team where your clinical knowledge helps improve patient outcomes, support appropriate care delivery, and make a meaningful difference for members every day.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Pay Range The typical pay range for this role is: $26.01 - $74.78