Remote RN Utilization Management Consultant

4062 Aetna Resources, LLC; Indiana (PA); Hybrid; USD 54,000 - 117,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced Registered Nurse (RN) for Utilization Management in a remote, work-from-home role within our 24/7 operations. You will review clinical documentation, coordinate care, and collaborate with care teams to ensure high-quality, cost-effective services.

The role requires an active RN license in your state, 2+ years of adult acute/critical care experience, and strong assessment and communication skills. BSN preferred but not required; associate degree required.

Qualifications

• Active RN license in residence state.
• 2+ years of adult acute and/or critical care nursing experience.
• Strong clinical assessment and communication skills.
• Ability to manage multiple priorities in a fast-paced, tech-driven environment.
• Proficiency navigating multiple computer systems.
• Associate Degree in Nursing required.

Responsibilities

• Review clinical documentation and apply criteria to support coverage determinations.
• Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care.
• Collaborate with providers and care teams to facilitate treatment plans and care coordination.
• Identify opportunities to improve healthcare quality and utilization.
• Connect members to additional programs and resources that support outcomes.
• Serve as a clinical resource to internal and external stakeholders.

Job description

CVS Health is seeking an experienced Registered Nurse (RN) for Utilization Management in a remote, work-from-home role within our 24/7 operations. You will review clinical documentation, coordinate care, and collaborate with care teams to ensure high-quality, cost-effective services.

The role requires an active RN license in your state, 2+ years of adult acute/critical care experience, and strong assessment and communication skills. BSN preferred but not required; associate degree required.