Utilization Management Nurse Consultant

CVS Health Careers

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

Posted 10/30/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $29 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong clinical assessment and decision-making skills while effectively coordinating and evaluating healthcare services. Proficient in utilizing multiple computer systems and applications to support evidence-based coverage determinations in a remote utilization management role.

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

Clinical AssessmentDecision-MakingHealthcare CoordinationUtilization ManagementTechnical TroubleshootingEHR Portal NavigationVPN AccessMultiple Monitor UsageEvidence-Based Criteria ApplicationQuality Improvement

Soft Skills

Excellent Communication SkillsAbility to Manage Competing PrioritiesOpenness to Learning

Tools & Technologies

Microsoft Office 365Google WorkspaceTeams MessagingVirtual Meeting PlatformsSecure Systems Access

Certifications & Qualifications

Active RN LicenseAssociate Degree in Nursing

Industry Keywords

Healthcare ServicesClinical ResourceHIPAA ComplianceMed-Surg NursingCritical Care NursingManaged Care

About the role

Key responsibilities & impact

Review clinical information and apply evidence-based criteria to support coverage determinations
Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
Collaborate with providers and care teams to facilitate appropriate treatment plans
Identify opportunities to improve quality, efficiency, and healthcare utilization
Connect members to additional programs and services as appropriate
Serve as a clinical resource for internal and external stakeholders
Work in a remote, non-bedside utilization management role
Work afternoon/evening shifts within a 24/7 operation
Work 40 hours per week

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 and decision-making skills
Ability to navigate multiple computer systems and manage competing priorities
Excellent verbal and written communication skills
Associate Degree in Nursing required
Willingness to work weekends, holidays, and evening shifts
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 workspace compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently living
Ability to use multiple monitors and applications simultaneously
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace applications
Ability to log in to secure systems such as VPN and EHR portals
Ability to follow computer security practices, including screen locking, strong passwords, and suspicious-link recognition
Ability to troubleshoot common technical issues and contact IT when needed
Openness to learning new skills
Preferred: 2+ years of Med-Surg or specialty nursing experience
Preferred: Managed Care experience, particularly Utilization Management
Preferred: Residence in the Eastern Time Zone
BSN preferred

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 eligibility