Registered Nurse (RN) - Utilization Management
Make an impact on patient care while working in a dynamic, collaborative environment. We're seeking an experienced Registered Nurse (RN) to join our Utilization Management team, where you'll help ensure members receive the right care at the right time through evidence-based clinical review and care coordination.
What You'll Do
- Review and assess clinical information to support coverage determinations and care recommendations.
- Apply clinical guidelines, policies, and professional judgment across the continuum of care.
- Collaborate with providers and healthcare teams to facilitate quality patient outcomes.
- Identify opportunities for care management referrals and member support programs.
- Promote effective healthcare utilization and quality improvement initiatives.
Required
- 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, multitasking, and computer navigation skills.
- Ability to work a flexible schedule, including evenings, weekends, and holidays as part of a 24/7 operation.
- Associates Degree in Nursing required.
Preferred
- 2+ years of Med-Surg or specialty clinical experience.
- Managed Care and/or Utilization Management experience.
- Candidates residing in CST/MST/PST locations preferred.
- BSN preferred
Why Apply?
- Opportunity to leverage your clinical expertise beyond direct bedside care.
- Collaborative, fast-paced environment focused on improving healthcare outcomes.
- Meaningful work that impacts patient care and healthcare quality every day.
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. WiFi and satellite internet are not permitted.
- 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, as this position would require you to be at your desk for extended periods of time).
- If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.
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, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
- 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
The typical pay range for this role is
$26.01 - $68.55