Remote Utilization Management RN Consultant

4062 Aetna Resources, LLC; California; Hybrid; USD 44,000 - 95,000; Full time

Benefits offered by this job

Bonus eligibility

Benefits package

Remote work

Job summary

CVS Health is seeking an experienced Registered Nurse for Utilization Management in a full-time, remote-capable role based in California. The position supports 24/7 operations including weekends and evenings, with a focus on coordinating care and benefits for members.

Responsibilities include gathering clinical information, applying criteria, communicating with providers, and identifying referral opportunities while maintaining HIPAA-compliant practices.

Qualifications

• 2+ years of RN experience in adult acute/critical/critical care settings.
• Active, current, unrestricted RN licensure in the state of residence.
• Utilization Management requires 24/7 coverage including weekends and evenings.

Responsibilities

• Assess, plan, implement, coordinate and evaluate options to provide appropriate healthcare services for members.
• Gather clinical information and apply criteria/guidelines to determine coverage decisions.
• Communicate with providers to facilitate care and coordinate treatment across settings.
• Identify referral opportunities to integrate with other CVS Health products and programs.
• Lend clinical expertise to internal/external stakeholders in UM operations.

Skills

RN experience in acute/critical care

HIPAA compliance

Education

RN licensure in state of residence

Associates Degree

BSN preferred

Job description

CVS Health is seeking an experienced Registered Nurse for Utilization Management in a full-time, remote-capable role based in California. The position supports 24/7 operations including weekends and evenings, with a focus on coordinating care and benefits for members.

Responsibilities include gathering clinical information, applying criteria, communicating with providers, and identifying referral opportunities while maintaining HIPAA-compliant practices.