Registered Nurse (RN) Utilization Management

CVS Health · Work from home, PA, PA · $26.01 - $74.78 · remote 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 Make an impact on patient care from wherever you are. We're seeking experienced Registered Nurses to join our Utilization Management team, where you'll use your clinical expertise to ensure members receive the appropriate care and resources they need throughout their healthcare journey. Responsibilities Review clinical information and apply evidence-based criteria to make coverage and authorization determinations. Collaborate with physicians, providers, and interdisciplinary teams to support quality patient outcomes. Identify opportunities for care coordination, case management, and other healthcare programs. Promote effective healthcare utilization and member-centered care. Serve as a clinical resource and partner for internal and external stakeholders. Requirements Active, unrestricted RN license in your state of residence. 2+ years of Registered Nurse experience in an adult acute care or critical care setting. Associate Degree in Nursing (ADN). Preferred Qualifications 2+ years of Med-Surg or specialty clinical experience. Utilization Management or Managed Care experience. BSN preferred. Candidates located in the Eastern Time Zone are strongly preferred. Schedule & Work Environment Utilization Management is a 24/7 operation; schedules may include evenings, weekends, and holidays. Fast-paced, collaborative environment requiring strong multitasking and communication skills. Computer-based role requiring navigation of multiple systems and documentation platforms. Benefits Medical, dental, and vision coverage. Paid time off. Retirement savings options. Wellness programs. 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 $26.01 - $74.78