Utilization Management Nurse Consultant

Job description

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, effici...