Utilization Management Nurse Consultant
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.
What You’ll Do
- 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
Schedule & Work Environment
- 100% remote (work from any U.S. state)
- Monday–Friday, 8:30am–5:00pm (local time zone)
- Occasional late shift coverage (up to 9:00pm EST, based on business needs)
- Weekend rotation and holiday rotation (typically 1 holiday per year)
- No travel required
Required Qualifications
- 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)
Preferred Qualifications
- 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
Education
- Associate Degree in Nursing required
- BSN preferred
Why Join Us?This role allows you to apply your clinical expertise at a system level—improving care quality and outcomes—while enjoying the flexibility of remote work and a collaborative, mission‑driven environment.
Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$29.10 - $62.32This 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. 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: 05/02/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. apply to this job