Utilization Management Nurse Consultant

4062 Aetna Resources, LLC; Rogers (AR); Remote; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring a Registered Nurse in Utilization Management to apply clinical guidelines and coordinate care decisions. The role supports members by linking them to programs and resources while coordinating with providers and care teams.

The position requires an active RN license, at least 2 years in adult acute or critical care, and strong clinical judgment. Flexible, office-based/remote work with 24/7 coverage expectations is offered.

Qualifications

• Active, unrestricted RN license in state of residence.
• Minimum 2 years of RN experience in adult acute care or critical care.
• Strong clinical judgment, communication, and organizational skills.
• Ability to work in a fast-paced environment while navigating multiple systems.
• Experience in Medical-Surgical or specialty nursing preferred.
• Managed Care and/or Utilization Management experience preferred.
• BSN preferred.
• Residents in Eastern Time Zone preferred.

Responsibilities

• Review clinical information and apply evidence-based guidelines to support coverage and care decisions.
• Collaborate with providers, care teams, and internal partners to coordinate appropriate healthcare services.
• Identify opportunities to improve care quality, outcomes, and benefit utilization.
• Support members through the continuum of care by connecting them to relevant programs and resources.
• Serve as a clinical resource for utilization and benefit management activities.

Skills

RN license

Utilization Management

Clinical judgment

Communication

Organizational skills

Adult acute/critical care experience

Education

Associate's Degree in Nursing

BSN preferred

Tools

VPN

EHR portal

Microsoft Office365

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. Make a difference beyond the bedside. Join our Utilization Management team and use your clinical expertise to help ensure members receive the right care at the right time.

What You'll Do

• Review clinical information and apply evidence-based guidelines to support coverage and care decisions.
• Collaborate with providers, care teams, and internal partners to coordinate appropriate healthcare services.
• Identify opportunities to improve care quality, outcomes, and benefit utilization.
• Support members through the continuum of care by connecting them to relevant programs and resources.
• Serve as a clinical resource for utilization and benefit management activities.

Required

• Active, unrestricted RN license in state of residence.
• Minimum 2 years of RN experience in adult acute care or critical care.
• Strong clinical judgment, communication, and organizational skills.
• Ability to work in a fast-paced environment while navigating multiple systems.

Preferred Qualifications

• Experience in Medical- Surgical or specialty nursing.
• Managed Care and/or Utilization Management experience.
• BSN preferred.
• Candidates residing in Eastern Time Zone preferred.

Schedule & Work Environment

Office‑based/remote computer‑focused role with productivity and quality expectations. Utilization Management operates 24/7; schedules may include evenings, weekends, and holidays.

Education

• Associate's Degree in Nursing required.
• BSN preferred.

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 Office365 (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

• medical coverage
• dental coverage
• vision coverage
• paid time off
• retirement savings options
• wellness programs
• 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: 10/03/2026

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

Our People

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. 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.