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.
Requisition Job Description:
Position Summary
This is a Work at Home role. Working hours are Mon-Fri 8-5pm in your time zone.
- Utilizes 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.
- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
- Communicates with providers and other parties to facilitate care/treatment
- Identifies members for referral opportunities to integrate with other products, services and/or programs
- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Required Qualifications
- 3+ years of experience as a Registered Nurse
- Must have active current and unrestricted RN licensure in state of residence
- 1+ years of infertility/Women's Health area
- 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)
- Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
Preferred Qualifications
- Prior Authorization or Utilization Management experience
- Managed care experience
- Experience using Med Compass
Education
- Associates degree in Nursing required
- Bachelor's in Nursing preferred
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
- 3+ years of experience as a Registered Nurse
- Active current and unrestricted RN licensure in state of residence
- 1+ years of infertility/Women's Health experience
- 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)
- Willingness to work holidays and evening hours (24/7 operation)
- Associate's degree in Nursing
- Prior Authorization or Utilization Management experience
- Managed care experience
- Experience using Med Compass
- Bachelor's degree in Nursing
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.
