# 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 per hour
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/PA---Work-from-home/Utilization-Management-Nurse-Consultant---Work-at-home---EST_R1080008?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_ee0a2dc6-4ac

## 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 they do.

**Job Details:**

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. You will gather clinical information, apply clinical criteria/guidelines, policies, procedures, and clinical judgment to render coverage determinations/recommendations along the continuum of care. Your responsibilities will also include communicating with providers and other parties to facilitate care/treatment, identifying members for referral opportunities, and promoting quality effectiveness of healthcare services and benefit utilization.

**Responsibilities:**

- Utilize clinical experience and skills to assess, plan, implement, coordinate, monitor, and evaluate options for facilitating appropriate healthcare services/benefits for members.

- Gather clinical information and apply clinical criteria/guidelines, policies, procedures, and clinical judgment to render coverage determinations/recommendations.

- 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 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.

**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 the computer with 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.

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

**Benefits:**

- Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.

**Pay Range:** $29.10 - $62.32 per hour

## Skills

### Required
- Registered Nurse
- Clinical Experience
- Microsoft Office 365
- Digital Communication Tools

### Nice to have
- Managed Care experience
- Utilization Management experience
- Med Surg or Specialty Area experience

---

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---Work-at-home---EST_R1080008?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)