Job Description:

• Review and assess clinical information to support coverage determinations
• Apply clinical guidelines, policies, and sound judgment across the care continuum
• Collaborate with providers and care teams to coordinate treatment plans
• Identify opportunities to enhance quality, efficiency, and member outcomes
• Refer members to additional programs and services as appropriate
• Serve as a clinical resource within utilization and benefit management
• Complete Monday–Friday training from 8:30 AM–5:00 PM EST
• Work a four-day weekend schedule from Friday through Monday with 10-hour shifts after training
• Work evening hours and occasional holidays within a 24/7 operation

Requirements:

• Active, unrestricted RN license in state of residence
• 3+ years of RN experience
• 1+ year of Med/Surg experience
• Proficiency with Microsoft Office (Outlook, Teams, Excel)
• Willingness to work the required schedule post-training
• Prior Authorization or Utilization Management experience preferred
• Managed care experience preferred
• MedCompass experience preferred
• Ambulatory surgery background preferred
• Associate’s degree required; BSN preferred
• Direct/hardwired internet connection to a modem/router within 7 feet of the computer, or ability to obtain one
• Minimum internet speed of 25 Mbps download and 3 Mbps upload
• Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines
• Must work within the state and city where currently living
• Ability to set up and use multiple monitors and navigate multiple applications simultaneously
• Ability to use Microsoft Office 365 applications or similar Google Workspace applications
• Ability to access secure systems such as VPN and EHR portals
• Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links
• Ability to troubleshoot common technical issues and contact IT when needed

Benefits:

• CVS Health bonus, commission or short-term incentive program in addition to base pay
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
• Company-provided equipment (keyboard, monitor, computer, headset, etc.)
• Professional growth opportunities