# 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/AZ---Work-from-home/Utilization-Management-Nurse-Consultant_R1089337?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/utilization-management-registered-nurse-d6600077-20b/

## 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.

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

**Responsibilities**

- Gather clinical information and apply clinical criteria/guidelines, policies, procedures, and clinical judgment to render coverage determinations/recommendations along the continuum of care.

- Communicate with providers and other parties to facilitate care/treatment.

- Identify members for referral opportunities to integrate with other products, services, and programs.

- Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.

- Consult and lend 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.

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

**Preferred Qualifications**

- 2+ years of clinical experience 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.

- Communication Tools: Ability to communicate on digital channels such as 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, 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.

**Work from Home Requirements**

- Direct/hardwired internet connection to a modem/router within 7 feet of your computer.

- Quiet, secure, and private designated home virtual work location.

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

**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.

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## Skills

### Required
- RN licensure
- clinical experience
- Microsoft Office 365

### 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/AZ---Work-from-home/Utilization-Management-Nurse-Consultant_R1089337?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)