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 passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Registered Nurse (RN) – Utilization Management
Remote | Afternoon/Evening Shifts Available | 24/7 Operations
Are you an experienced RN looking to bring your clinical expertise to a fast-paced, collaborative Utilization Management team? Join us in helping ensure members receive the appropriate care and benefits while making a meaningful impact on healthcare outcomes.
What You'll Do
Review clinical information and apply evidence-based criteria to support coverage determinations
Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
Collaborate with providers and care teams to facilitate appropriate treatment plans
Identify opportunities to improve quality, efficiency, and healthcare utilization
Connect members to additional programs and services as appropriate
Serve as a clinical resource for internal and external stakeholders
WHAT YOU BRING - REQUIRED
Active, unrestricted RN license in your state of residence
2+ years of adult acute care and/or critical care nursing experience
Strong clinical assessment and decision-making skills
Ability to navigate multiple computer systems and manage competing priorities
Excellent verbal and written communication skills
Associate Degree in Nursing required
Willing to work weekends, holidays, and evening shifts.
Preferred Qualifications
2+ years of Med-Surg or specialty nursing experience
Managed Care experience, particularly Utilization Management
Reside in the Eastern Time Zone
BSN preferred
Why Join Us?
Use your clinical expertise in a non-bedside role
Collaborate with experienced healthcare professionals
Influence care quality and member outcomes on a broad scale
Work in a dynamic environment that values critical thinking and clinical judgment
If you're a compassionate RN who thrives in a fast-paced environment and enjoys combining clinical expertise with care coordination, we'd love to hear from you. Apply today!
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
40Time Type
Full timePay Range
The typical pay range for this role is:
$29.10 - $62.32This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Active, unrestricted RN license in state of residence
- 2+ years of adult acute care and/or critical care nursing experience
- Associate Degree in Nursing
- Strong clinical assessment and decision-making skills
- Ability to navigate multiple computer systems and manage competing priorities
- Excellent verbal and written communication skills
- Willingness to work weekends, holidays, and evening shifts
- Direct/hardwired internet connection to modem/router within 7 feet with minimum 25 Mbps download and 3 Mbps upload (WiFi and satellite not permitted)
- Quiet, secure, private HIPAA-compliant home workspace
- Work from Home colleagues must work within the state and city where they live
- Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously
- Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar (Google Workspace)
- Ability to log in to secure systems (e.g., VPN, EHR portal), manage strong passwords, lock computer when unattended, and recognize suspicious emails/links
- Ability to resolve common technical issues and contact IT for unresolved problems
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
