Utilization Management Nurse Consultant

CVS Health; City of Albany (NY); Remote; Full time

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant for its LTSS team. This fully remote role requires a New York RN license and involves applying medical necessity guidelines to service requests. The position offers a flexible schedule and comprehensive benefits.

Benefits

Medical Plans

401(k)

Employee Stock Purchase

Wellness Programs

Paid Time Off

Flexible Schedules

Family Leave

Qualifications

• 1+ year of Utilization review experience.
• 1+ year of clinical experience.

Responsibilities

• Utilizing MCG rules and applying medical necessity guidelines.
• Working closely with leadership and the Medical Director.

Skills

Utilization Review

Clinical Experience

Education

Bachelor's Degree in Nursing

Job description

Join to apply for the Utilization Management Nurse Consultant role at CVS Health.

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues – caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Position Summary

This Utilization Manager position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a fully remote role. Candidates must hold a New York Registered Nurse License.

The employee will work four 10-hour days per week.

This role involves utilizing MCG rules and applying medical necessity guidelines to service requests, working closely with leadership and the Medical Director to ensure timely responses within allowable turnaround times.

Required Qualifications

• Registered Nurse with active and unrestricted New York state licensure
• 1+ year of Utilization review experience
• 1+ year of clinical experience

Preferred Qualifications

• Managed Care or Managed Long Term Care experience
• Prior Authorizations
• Medicaid and Medicare Processes

Education

• Minimum of a Bachelor's Degree in Nursing required

Additional Details

• Anticipated Weekly Hours: 40
• Time Type: Full time
• Pay Range: $32.01 - $68.55 per hour
• Application deadline: 06/14/2025

Benefits

Our benefits include medical plans, 401(k), employee stock purchase, wellness programs, paid time off, flexible schedules, family leave, and more. For details, visit https://jobs.cvshealth.com/us/en/benefits.