Utilization Management Registered Nurse (RN) - Remote
Make a meaningful impact on patient care from wherever you work. We are seeking an experienced Registered Nurse (RN) to join our Utilization Management team, where you'll use your clinical expertise to help ensure members receive appropriate, high-quality healthcare services and benefits.
What You'll Do
- Review and assess clinical information to support coverage determinations and recommendations.
- Apply evidence-based clinical criteria, policies, and professional judgment across the continuum of care.
- Collaborate with providers and interdisciplinary teams to coordinate care and promote positive member outcomes.
- Identify opportunities for quality improvement, care integration, and effective benefit utilization.
- Serve as a clinical resource for internal and external stakeholders.
Required Qualifications
- Active, unrestricted RN license in your state of residence.
- Minimum 2 years of RN experience in an adult acute care or critical care setting.
- Associates degree in nursing.
Preferred Qualifications
- 2+ years of Med-Surg or specialty clinical experience.
- Utilization Management and/or Managed Care experience.
- Strong communication, critical thinking, and computer navigation skills.
- Ability to thrive in a fast-paced environment and manage multiple priorities.
- Candidates located in the Eastern Time Zone are strongly preferred.
- BSN preferred.
Schedule
This is a 24/7 operation, and schedules may include evenings, weekends, and holidays.
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 - $74.78