Utilization Management Nurse Consultant

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues — caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day. Position Summary This Utilization Manager position is with Aetna's Long-Term Services and Supports (LTSS) team and is a fully remote role. Candidates must hold a New York Registered Nurse license. The employee will work four 10-hour days per week. This role involves utilizing MCG rules and medical necessity guidelines to review service requests, working closely with leadership and the Medical Director to ensure timely processing within specified turnaround times. Required Qualifications Active and unrestricted Registered Nurse license in New York At least 1 year of utilization review experience At least 1 year of clinical experience Preferred Qualifications Managed Care or Managed Long Term Care experience Experience with Prior Authorizations Knowledge of Medicaid and Medicare processes Education Bachelor's Degree in Nursing or higher Work Schedule and Compensation Anticipated weekly hours: 40 Time type: Full-time Pay range: $32.01 - $68.55 per hour, depending on experience and other factors. The role is eligible for bonuses and incentives. Benefits Comprehensive benefits include medical plans, 401(k), employee stock purchase plan, wellness programs, paid time off, flexible schedules, family leave, and more. For details, visit CVS Benefits . Additional Information This application window closes on 06/03/2025. Qualified applicants with arrest or conviction records will be considered per applicable laws. #J-18808-Ljbffr