Utilization Management Nurse Consultant

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

About the Role

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Registered Nurse (RN) – Utilization Management

Join a dynamic healthcare team where your clinical expertise helps ensure members receive the right care at the right time. We are seeking an experienced Registered Nurse (RN) to support our Utilization Management team. In this role, you will review clinical information, apply evidence-based criteria and clinical judgment, communicate with providers, and help coordinate effective, high-quality healthcare services for members.

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

Required Qualifications

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

Preferred Qualifications

• 2+ years of Med-Surg or specialty clinical experience
• Managed Care and/or Utilization Management experience
• Candidates residing in Eastern time zones preferred
• BSN

Schedule & Work Environment

Utilization Management operates 24/7 Monday – Friday 8:00 am to 5:00 pm in the time zone where you live. Schedules include evenings (until 7pm), weekends, and holidays (based on business needs). Remote/office-based environment with extensive computer and telephone use Sedentary role requiring effective multitasking and navigation of multiple systems

Work From Home Requirements

• Direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload
• WiFi and satellite internet are not permitted
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live
• The company will provide equipment (keyboard, monitor, computer, headset, etc.)
• All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time)
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace)
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues

Future Growth

Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $32.01 - $68.55 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Benefits

Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Application Window

We anticipate the application window for this opening will close on: 09/26/2026

Equal Opportunity Statement

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Company Culture

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.