Utilization Management Nurse Consultant

CVS Health Careers

. Review clinical information and apply evidence-based criteria to support coverage determinations .

Posted 11/10/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $26 - $75 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates strong clinical judgment and communication skills while applying evidence-based criteria for coverage determinations. Proficient in utilizing technology and managing care in a remote setting to enhance healthcare quality and member experience.

Highest-signal resume keywords

Active RN License2+ Years RN ExperienceUtilization Management ExperienceMicrosoft Office 365 ProficiencyMedical-Surgical Nursing Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical JudgmentEvidence-Based Criteria ApplicationUtilization ManagementMedical-Surgical NursingCritical Care NursingComputer SkillsTroubleshooting Technical IssuesNavigating Multiple ApplicationsVPN AccessEHR Portal Access

Soft Skills

CollaborationCommunicationOpenness to LearningTeamworkAdaptability

Tools & Technologies

Microsoft Office 365Google WorkspaceTeams MessagingVirtual Meeting PlatformsSecure Systems

Certifications & Qualifications

Associate Degree in Nursing (ADN)Active RN License

Industry Keywords

Healthcare QualityManaged CareInterdisciplinary TeamsPatient Care CoordinationHIPAA Compliance

About the role

Key responsibilities & impact

Review clinical information and apply evidence-based criteria to support coverage determinations
Collaborate with providers and interdisciplinary teams to coordinate care and optimize outcomes
Identify opportunities to improve healthcare quality, efficiency, and member experience
Connect members with additional programs and services when appropriate
Serve as a clinical resource for utilization and benefit management activities
Work in a fast-paced, team-oriented remote setting with productivity and quality goals
Work a flexible schedule including evenings, weekends, and holidays as part of a 24/7 operation

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of RN experience in adult acute care or critical care
Associate Degree in Nursing (ADN)
Candidates located in the Eastern or Central Time Zone
Strong clinical judgment, communication, and computer skills
Experience in Medical-Surgical or specialty nursing
Utilization Management or Managed Care experience
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
Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines
Ability to work within the state and city where currently living
Ability to provide workspace furniture
Ability to use multiple monitors and navigate 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 security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links
Ability to troubleshoot common technical issues independently
Openness to learning new skills as the workplace evolves

Benefits

Comp & perks

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.)
CVS Health bonus, commission or short-term incentive program in addition to base pay
Flexible scheduling, including evenings, weekends, and holidays as part of a 24/7 operation