Utilization Management Nurse Consultant
About The Position
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. Utilization Management Nurse Consultant (RN) – Remote Commercial Care Management | Nationwide Are you an experienced RN looking to use your clinical expertise beyond the bedside—while working fully remote? Join Aetna’s Commercial Care Management team and help ensure members receive the right care, at the right time, in the right setting.
Requirements
- Active, unrestricted RN license in your state of residence
- 2+ years of RN clinical experience (all clinical settings considered)
- Comfortable working full‑time remote with rotating schedule needs (weekends and holidays)
- Proficiency with Microsoft Office (Word, Excel, Outlook, PowerPoint)
Nice To Haves
- Utilization Review and/or Managed Care experience
- Strong phone‑based communication skills
- Ability to multitask across systems while engaging providers
- Independent decision‑making with strong organization and time‑management skills
Responsibilities
- Review clinical records to assess medical necessity and appropriate benefit utilization
- Coordinate with providers and facilities to support safe, timely, and efficient care transitions
- Apply clinical guidelines and sound judgment to render coverage recommendations
- Communicate clearly with providers and internal partners to facilitate care
- Identify opportunities to improve quality, efficiency, and care integration across services
Benefits
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
