Utilization Management Nurse Consultant (Weekend)

4062 Aetna Resources, LLC; Pennsylvania; Hybrid; USD 40,000 - 86,000; 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 qualified Registered Nurse for a remote Utilization Management role. You will assess and coordinate care, apply clinical criteria, and collaborate with providers to ensure appropriate services for members.

Responsibilities include reviewing cases, communicating with care teams, and promoting quality while meeting productivity standards. This full-time, work-from-home position offers comprehensive benefits.

Qualifications

• Registered Nurse with current RN licensure in the state of residence.
• 3+ years of RN experience; 1+ year in acute or post-acute settings.
• 1+ year in Utilization Management/Care Management.

Responsibilities

• Gather clinical information and apply clinical criteria to render coverage determinations.
• Communicate with providers and other parties to facilitate care and referrals.
• Identify opportunities to promote quality and effectiveness of care.
• Consult and lend expertise to others in coordination and administration of UM/Care Management.
• Meet productivity and quality expectations as established by UMNC.

Skills

Verbal and written communication

Computer skills

Multitasking and prioritization

Extended sitting/phone use

Education

RN diploma or better

Active RN license in state of residence

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.

Schedule:

This is an Alternative Work Schedule weekend position. The role requires coverage of both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage.

Position Summary:

Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.

Key Responsibilities:

• Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care.
• Communicate with providers and other parties to facilitate care and treatment. Identify members for referral opportunities to integrate with other products, services, or benefit programs.
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Meet set productivity and quality expectations as established by UMNC.

Required Skills and Abilities:

• Effective verbal and written communication skills.
• Proficiency with computer skills, including navigating multiple systems and keyboarding.
• Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.
• Capacity to sit for extended periods, talk on the telephone, and type on the computer.

Work Location:

This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed.

Required Qualifications

Registered Nurse Education: Diploma RN acceptable; Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience Must have active current and unrestricted RN licensure in state of residence. May be required to obtain additional Nursing Licenses as business needs require.

• Preferred Qualifications - Utilization Management experience preferred

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 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.

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.

We anticipate the application window for this opening will close on: 11/16/2026 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.