Utilization Management Nurse Consultant

CVS Health Careers

. Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members .

Posted 11/3/2026full-timeRemote • Kansas • 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 healthcare service coordination, clinical assessment, and utilization management, with a strong focus on effective communication and quality improvement in patient care. Proficient in navigating clinical guidelines and applying clinical judgment to support coverage determinations.

Highest-signal resume keywords

Registered Nurse LicensureClinical Experience in Med Surg or Specialty AreaHealthcare Service CoordinationEffective Communication SkillsAbility to Multitask and Adapt

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical AssessmentCoverage DeterminationsUtilization ManagementClinical Criteria ApplicationHealthcare Service Quality Improvement

Soft Skills

Effective Verbal CommunicationEffective Written CommunicationPrioritizationAdaptabilityMultitasking

Tools & Technologies

Computer ProficiencyMultiple Systems Navigation

Certifications & Qualifications

Active RN LicensureAssociates Degree

Industry Keywords

Adult Acute CareCritical CareHealthcare ServicesBenefit UtilizationClinical Guidelines

About the role

Key responsibilities & impact

Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members
Gather clinical information and apply clinical criteria, guidelines, policies, procedures and clinical judgment to render coverage determinations or recommendations across the continuum of care
Communicate with providers and other parties to facilitate care and treatment
Identify members for referral opportunities involving other products, services and programs
Identify opportunities to promote healthcare-service quality, effectiveness and benefit utilization
Consult with and provide expertise to internal and external constituents regarding utilization and benefit management
Work in a typical office environment while meeting productivity and quality expectations

Requirements

What you’ll need

2+ years of experience as a Registered Nurse in adult acute care/critical care setting
Active, current and unrestricted RN licensure in state of residence
Associates Degree required
Clinical experience in med surg or specialty area
Ability to work weekends, holidays, and evening hours in a 24/7 operation
Proficiency with computer skills, including navigating multiple systems and keyboarding
Effective verbal and written communication skills
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
Ability to perform close inspection of handwritten and computer-generated documents and a PC monitor
Ability to sit for extended periods, talk on the telephone, and type on the computer

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
CVS Health bonus, commission or short-term incentive program in addition to base pay