CVS Health Aetna is hiring a full-time Utilization Management (UM) Nurse Consultant. You'll be reviewing clinical cases, assessing medical necessity, and making sure members are getting the right care at the right time — all while staying within federal and state turnaround requirements.

It's a remote, desk-based clinical role. Most of your work involves reviewing written records, communicating with providers and facilities, and applying clinical judgment to coverage decisions.

Responsibilities

• Review services for medical necessity using clinical criteria and guidelines
• Coordinate discharge planning and work with facilities to meet complex member needs
• Assess, plan, and monitor appropriate healthcare services for members
• Gather clinical information and make coverage determinations across the care continuum
• Communicate with providers to facilitate care and resolve issues
• Identify members for referral to additional programs or services
• Support health strategies that promote member wellness and timely return to work

Requirements

• Active, unrestricted RN license in your state of residence — required
• 2+ years clinical experience as a registered nurse
• 2+ years utilization management experience
• Associate's degree in Nursing minimum; BSN preferred
• Must be willing to travel to a local office occasionally if within ~45 miles
• Bilingual (English/Spanish) is a plus
• Comfortable working across multiple computer systems and Microsoft Office tools

Pay & Benefits

• $26.01 – $74.78/hour base pay
• Eligible for bonus/short-term incentive program
• Medical plan options + 401(k) with company match + employee stock purchase plan
• Paid time off, flexible schedules, family leave
• Tuition assistance, wellness programs, confidential counseling
• No-cost tobacco cessation, weight management, and financial coaching programs

Full benefits info: jobs.cvshealth.com/us/en/benefits