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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.
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