Remote RN Utilization Management Specialist

4062 Aetna Resources, LLC; Maryland; Hybrid; USD 67,000 - 143,000; 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 a Registered Nurse (RN) for Utilization Management to review clinical information, apply criteria, and coordinate care with providers to ensure appropriate, high-quality services for members. The role supports outcomes through evidence-based decision-making and collaboration with care teams.

The position offers a remote/office-based work environment, with 24/7 availability and a comprehensive benefits package.

Qualifications

• Active, unrestricted RN license in state of residence.
• 2+ years of RN experience in adult acute care or critical care.
• Strong clinical assessment, communication, and computer skills.
• Ability to thrive in a fast-paced, highly collaborative environment.
• Associates Degree in Nursing.

Responsibilities

• Review and assess clinical information to support utilization and coverage determinations.
• Collaborate with providers, care teams, and internal partners to facilitate appropriate treatment and care plans.
• Identify opportunities for care management referrals and member support programs.
• Promote quality, cost-effective healthcare outcomes.
• Serve as a clinical resource for utilization and benefit management activities.

Skills

RN licensure

RN experience 2+ yrs

Clinical assessment

Communication

Computer skills

Team collaboration

Education

Associates Degree in Nursing

BSN (preferred)

Job description

CVS Health is seeking a Registered Nurse (RN) for Utilization Management to review clinical information, apply criteria, and coordinate care with providers to ensure appropriate, high-quality services for members. The role supports outcomes through evidence-based decision-making and collaboration with care teams.

The position offers a remote/office-based work environment, with 24/7 availability and a comprehensive benefits package.