At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues.
Position Summary
Utilization Management is a 24/7 operation. Work schedules will include weekends, holidays, and evening hours.
Responsibilities
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.
Works in a typical office environment with productivity and quality expectations.
Requires the ability to perform close inspection of handwritten and computer‑generated documents and use a PC monitor.
Involves periods of sitting, talking, listening; requires sitting for extended periods, talking on the telephone, and typing on the computer.
Must be able to multitask, prioritize and effectively adapt to a fast‑paced and changing environment.
Requires proficiency with computer skills, navigating multiple systems and keyboarding.
Demonstrates effective verbal and written communication skills.
Required Qualifications
3+ years of clinical experience as a Registered Nurse in adult acute care/critical care setting.
Must have active current and unrestricted RN licensure in state of residence.
Work schedules will include weekends, holidays, and evening hours (24/7 operation).
Preferred Qualifications
2+ years of clinical experience in med‑surg or specialty area.
Managed Care experience preferred, especially Utilization Management.
Preference for those residing in EST zones.
Education
Associate's Degree in Nursing required. BSN preferred.
Anticipated Weekly Hours
40
Time Type
Full Time
Pay Range
$26.01 - $56.14 per hour. The actual base salary will depend on experience, education, geography and other factors. This position may be eligible for a bonus, commission or short‑term incentive program.
Great Benefits for Great People
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No‑cost programs including wellness screenings, tobacco cessation, weight management, confidential counseling and financial coaching.
Benefit solutions addressing diverse needs: paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and more, depending on eligibility.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We anticipate the application window for this opening will close on: 12/05/2025.