Remote Utilization Management RN Consultant

4062 Aetna Resources, LLC; California; Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health seeks a Registered Nurse for Utilization Management in California. This full‑time role supports a 24/7 operation, with weekends, holidays and evening hours.

You’ll use clinical judgment to render coverage determinations and coordinate care for members, communicating with providers and care teams. The ideal candidate has 2+ years in adult acute/critical care, an RN license, and experience with managed care.

Qualifications

• 2+ years of RN experience in adult acute/critical care settings.
• Active, current, and unrestricted RN licensure in state of residence.
• Utilization Management is a 24/7 operation with weekend, holiday, and evening hours.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members.
• Render coverage determinations/recommendations using clinical criteria/guidelines.
• Communicate with providers and teams to coordinate patient care and referrals.

Skills

RN licensure

Adult acute/critical care

Clinical judgment

Education

Associates Degree

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health seeks a Registered Nurse for Utilization Management in California. This full‑time role supports a 24/7 operation, with weekends, holidays and evening hours.

You’ll use clinical judgment to render coverage determinations and coordinate care for members, communicating with providers and care teams. The ideal candidate has 2+ years in adult acute/critical care, an RN license, and experience with managed care.