Description: Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours. Fully remote work from home in CST zone. No travel is required. 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. Requirements: Must reside in CST zone. 3+ years of experience as an RN. 1+ year of inpatient/outpatient hospital experience, specifically Med/Surg. Must have active, current and unrestricted RN licensure in state of residence. 1+ years of experience working in multiple IT platforms/systems. 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel). Must be willing and able to work Monday through Friday 8:00 am to 5:00 pm CST with rotating late evening and weekend shifts. Benefits: Full range of medical, dental, and vision benefits. 401(k) retirement savings plan. Employee Stock Purchase Plan. Fully-paid term life insurance plan. Short-term and long-term disability benefits. Numerous well-being programs. Education assistance and free development courses. CVS store discount. Paid Time Off (PTO) and paid holidays. Apply Job!