Utilization Management Nurse Consultant

4062 Aetna Resources, LLC; New York (NY); Hybrid; USD 91,704,000 - 196,258,000; Full time

Job summary

CVS Health is seeking a Registered Nurse (RN) to support 24/7 Utilization Management operations in a remote capacity. You will review cases, assess medical necessity, coordinate care, and ensure members receive high-quality healthcare services.

Requirements include an active RN license, 2+ years in adult acute/critical care, an ADN, and strong communication plus multitasking skills. Flexible schedule with weekend/evening hours may be needed.

Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years of RN experience in adult acute or critical care.
• Associate Degree in Nursing.
• Strong communication, multitasking, and computer navigation skills.
• Evening, weekend, and holiday shifts as needed.

Responsibilities

• Review clinical information and apply evidence-based criteria for coverage and care.
• Collaborate with providers and care teams to coordinate treatment.
• Identify opportunities to improve quality and benefit utilization.
• Refer members to programs and services supporting health needs.
• Serve as a clinical resource for utilization and benefit management questions.

Skills

Strong communication

Multitasking

Computer navigation

Education

Associate Degree in Nursing

BSN preferred

Job description

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 and make an impact on patient care from wherever you work. We are seeking an experienced Registered Nurse (RN) to support our 24/7 Utilization Management operations. In this role, you will use your clinical expertise to review cases, assess medical necessity, coordinate care, and help ensure members receive appropriate, high-quality healthcare services.

What You’ll Do

• Review clinical information and apply evidence-based criteria to support coverage determinations and care recommendations.
• Collaborate with providers, care teams, and internal partners to coordinate treatment and services.
• Identify opportunities to improve healthcare quality, outcomes, and benefit utilization.
• Refer members to appropriate programs and services that support their overall health needs.
• Serve as a clinical resource for utilization and benefit management questions.

What We’re Looking For

Required Qualifications

• Active, unrestricted RN license in your state of residence.
• 2+ years of RN experience in an adult acute care or critical care setting.
• Associate Degree in Nursing.
• Strong communication, multitasking, and computer navigation skills.
• Ability to work a designated schedule of 8:00 am to 5:00 PM ET, including weekends, holidays, and evening hours based on business needs.

Preferred Qualifications

• BSN preferred.
• Clinical experience in Med-Surg or a specialty area.
• Managed Care and/or Utilization Management experience.
• Candidates located in the Eastern Time Zone preferred.

Why Join Us?

Apply your clinical expertise in a collaborative, fast-paced environment. Help improve healthcare outcomes for members across the continuum of care. Work with a mission-driven team focused on quality, efficiency, and patient-centered care.

Ready to leverage your nursing experience in a rewarding Utilization Management role?

Work from Home Requirements

• You must have or be able to obtain a 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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

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.

• 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.

We anticipate the application window for this opening will close on: 10/24/2026

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

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.