Utilization Management Nurse Consultant - Medical Review (Remote)

Clinical Careers Page(1 month ago)

RemoteFull TimeSenior$52,020 - $112,280Utilization Management

About this role

A Utilization Management (UM) Nurse Consultant (Medical Review) at Aetna/CVS Health performs clinical review to help ensure members receive timely, medically necessary care. This fully remote role applies nursing expertise and clinical judgment in a desk-based environment within an accredited medical management organization.

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Required Skills

Medical Review
Utilization Management
Clinical Documentation
Critical Thinking
Policy Interpretation
Provider Collaboration
Process Improvement
Training
Communication

Qualifications

Active Unrestricted RN License
Multistate/Compact Licensure Privileges
Associate's Degree in Nursing (RN)
BSN Preferred
Minimum 3 Years Clinical Experience
5 Years Independent Clinical Decision-Making
1+ Year Utilization Review/Medical Management Experience

About Clinical Careers Page

cvshealth.com

CVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.

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