# Utilization Management Registered Nurse

**Company**: CVS Health
**Location**: Work from home, 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_R0964159-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/utilization-management-registered-nurse-3ed29634-52c/

## 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 hand written 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 adult acute care/critical care setting.

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

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

**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 ET zones.

**Education**

- Associates Degree required.

- BSN preferred.

**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
- Registered Nurse
- clinical experience
- computer skills
- communication skills

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

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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_R0964159-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)