Remote RN - Utilization Management Clinician

4062 Aetna Resources, LLC; Rogers (AR); Remote; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring a Registered Nurse in Utilization Management to apply clinical guidelines and coordinate care decisions. The role supports members by linking them to programs and resources while coordinating with providers and care teams.

The position requires an active RN license, at least 2 years in adult acute or critical care, and strong clinical judgment. Flexible, office-based/remote work with 24/7 coverage expectations is offered.

Qualifications

• Active, unrestricted RN license in state of residence.
• Minimum 2 years of RN experience in adult acute care or critical care.
• Strong clinical judgment, communication, and organizational skills.
• Ability to work in a fast-paced environment while navigating multiple systems.
• Experience in Medical-Surgical or specialty nursing preferred.
• Managed Care and/or Utilization Management experience preferred.
• BSN preferred.
• Residents in Eastern Time Zone preferred.

Responsibilities

• Review clinical information and apply evidence-based guidelines to support coverage and care decisions.
• Collaborate with providers, care teams, and internal partners to coordinate appropriate healthcare services.
• Identify opportunities to improve care quality, outcomes, and benefit utilization.
• Support members through the continuum of care by connecting them to relevant programs and resources.
• Serve as a clinical resource for utilization and benefit management activities.

Skills

RN license

Utilization Management

Clinical judgment

Communication

Organizational skills

Adult acute/critical care experience

Education

Associate's Degree in Nursing

BSN preferred

Tools

VPN

EHR portal

Microsoft Office365

Job description

CVS Health is hiring a Registered Nurse in Utilization Management to apply clinical guidelines and coordinate care decisions. The role supports members by linking them to programs and resources while coordinating with providers and care teams.

The position requires an active RN license, at least 2 years in adult acute or critical care, and strong clinical judgment. Flexible, office-based/remote work with 24/7 coverage expectations is offered.