RN Utilization Management Specialist - Remote

4062 Aetna Resources, LLC; New York (NY); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical cover

Dental cover

Vision cover

Paid time off

Job summary

CVS Health is seeking an experienced Registered Nurse for Utilization Management. This 24/7 role requires clinical expertise to assess and coordinate care, determine coverage and promote optimal health outcomes.

You will engage with providers and internal teams to ensure compliant, efficient utilization of benefits. The position involves weekend, holiday, and evening hours, with strong emphasis on clinical judgment, documentation, and communication in a fast-paced environment.

Qualifications

• 2+ years of RN experience in adult acute/critical care.
• Active, current and unrestricted RN license in the state of residence.
• Willingness to work weekends, holidays, and evenings in a 24/7 Utilization Management setting.

Responsibilities

• Utilizes clinical experience to assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services/benefits.
• Communicates with providers and other parties to facilitate care/treatment and to render coverage determinations/recommendations.
• Identifies referral opportunities to integrate with other products, services and programs.
• Lends expertise to internal/external constituents in coordination of utilization/benefit management and works in a fast-paced environment.

Skills

RN licensure

Adult acute/CCU care

Clinical assessment

Education

Associates degree

BSN preferred

Job description

CVS Health is seeking an experienced Registered Nurse for Utilization Management. This 24/7 role requires clinical expertise to assess and coordinate care, determine coverage and promote optimal health outcomes.

You will engage with providers and internal teams to ensure compliant, efficient utilization of benefits. The position involves weekend, holiday, and evening hours, with strong emphasis on clinical judgment, documentation, and communication in a fast-paced environment.