Utilization Management Nurse Consultant

CVS Health Careers

. Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations .

Posted 11/10/2026full-timeRemote • Kentucky • United StatesJuniorMid-Level💰 $26 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical assessment, critical thinking, and decision-making within a Utilization Management role, while effectively collaborating with healthcare providers and teams to enhance member outcomes and care quality.

Highest-signal resume keywords

Active RN License2+ Years Adult Acute Care ExperienceClinical Assessment SkillsUtilization Management ExperienceMicrosoft Office 365 Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Critical ThinkingDecision-MakingMultitaskingHealthcare CoordinationQuality ImprovementEHR NavigationTechnical Issue ResolutionComputer System ProficiencyHIPAA ComplianceCare Planning

Soft Skills

Verbal CommunicationWritten CommunicationCollaborationFast-Paced Work AdaptabilityInterpersonal Skills

Tools & Technologies

Microsoft Office 365Google WorkspaceVPN AccessEHR PortalsTeams Messaging

Certifications & Qualifications

RN LicenseAssociate Degree in NursingBSN Preferred

Industry Keywords

Utilization ManagementManaged CareHealthcare ServicesMember OutcomesClinical Guidelines

About the role

Key responsibilities & impact

Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations
Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care
Collaborate with providers and care teams to facilitate appropriate treatment and care planning
Identify opportunities to improve quality of care, member outcomes, and healthcare utilization
Connect members with additional programs and resources supporting their healthcare needs
Serve as a clinical resource for internal and external stakeholders
Work remotely in a computer-based Utilization Management role with productivity and quality expectations
Collaborate frequently with providers, members, and interdisciplinary healthcare teams
Work schedules that may include evenings, weekends, and holidays because Utilization Management operates 24/7

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of adult acute care and/or critical care nursing experience
Strong clinical assessment, critical thinking, and decision-making skills
Excellent verbal and written communication skills
Ability to multitask and work effectively in a fast-paced environment
Proficiency navigating multiple computer systems and applications
Associate Degree in Nursing required
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 25 Mbps download and 3 Mbps upload
WiFi and satellite internet are not permitted
Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently living
Must provide workspace furniture, such as a desk or standing desk
Comfortable setting up and using multiple monitors and navigating multiple applications
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace applications
Ability to access secure systems such as VPN and EHR portals
Ability to follow computer and password security practices and recognize suspicious emails or links
Ability to resolve common technical issues independently
Preferred: 2+ years of Med-Surg or specialty nursing experience
Preferred: Managed Care or Utilization Management experience
Preferred: Residence in the Eastern Time Zone
BSN preferred

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
Remote work from home