# Registered Nurse (RN) - Utilization Management **Company**: CVS Health **Location**: Work from hom, OH **Work arrangement**: remote **Experience**: senior **Job type**: full-time **Salary**: $26.01 - $74.78 **Category**: Healthcare **Industry**: Healthcare **Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/OH---Work-from-hom/Utilization-Management-Nurse-Consultant_R1088479?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/job/registered-nurse-rn-utilization-management-b24c9b64-630/ ## 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. **Registered Nurse (RN) - Utilization Management** **Location:** Remote (Preference for candidates in CST or EST time zones) **Schedule:** 24/7 operation requiring flexibility for evenings, weekends, and holidays Are you an experienced RN looking to leverage your clinical expertise in a dynamic, collaborative environment? Join our Utilization Management team and play a critical role in ensuring members receive appropriate, high-quality healthcare services. **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. - 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. **Requirements** - Active, unrestricted RN license in your state of residence. - 2+ years of RN experience in adult acute care or critical care settings. **Preferred Qualifications** - 2+ years of Med-Surg or specialty clinical experience. - Managed Care and/or Utilization Management experience. - Strong clinical assessment, communication, and multitasking skills. - Comfortable working in a fast-paced, technology-driven environment. - BSN preferred. **Education** - Associate Degree in Nursing required. - BSN preferred. **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 25 mbs download and 3 mbs 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.). - All new hires should provide their own workspace furniture (desk or standing desk). **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. - Future Growth: Openness to learning new skills in the future as the workplace environment evolves. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** $26.01 - $74.78 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. **Benefits** We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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. For more fresh new jobs, check out [yubhub.co](https://yubhub.co/). ## Skills ### Required - RN license - clinical experience - communication skills - computer skills ### Nice to have - Med-Surg experience - Managed Care experience - Utilization Management experience - BSN degree --- 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_R1088479?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)