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 11/11/2026full-timeRemote • Illinois • United StatesJuniorMid-Level💰 $32 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in Utilization Management and clinical assessment, with a strong focus on effective communication and coordination of healthcare services. Proficient in navigating multiple systems and ensuring compliance with healthcare guidelines and regulations.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceClinical Assessment SkillsMicrosoft Office 365 ProficiencyEffective Communication Skills

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 AssessmentUtilization ManagementHealthcare Services CoordinationClinical Criteria ApplicationDocument InspectionTechnical Issue ResolutionKeyboarding ProficiencyVPN AccessEHR NavigationInternet Speed Management

Soft Skills

Effective Verbal CommunicationEffective Written CommunicationInterpersonal SkillsOrganizational SkillsProblem-Solving Skills

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNEHR PortalsTeams Messaging

Certifications & Qualifications

Active RN LicensureAssociates Degree

Industry Keywords

Managed CareHealthcare QualityBenefit UtilizationHIPAA ComplianceAdult Acute CareCritical CareMed Surg

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 judgment to render coverage determinations or recommendations
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 and effective benefit utilization
Consult and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management
Work a Monday-Friday schedule from 8:00 AM to 5:00 PM CST, with 12 weekend shifts per year, occasional weekend shifts, and 2 holidays per year, subject to change

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
2+ years of clinical experience in med surg or specialty area
Managed Care experience preferred, especially Utilization Management
Preference for those residing in CST zones
Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously
Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace applications
Ability to log in to secure systems such as VPN and EHR portals, lock computer screens, manage strong passwords, and recognize suspicious emails or links
Ability to resolve common technical issues independently and contact IT for unresolved issues
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 50 Mbps download and 5 Mbps upload
WiFi and satellite internet are not permitted
Quiet, secure and private designated home work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently residing
Ability to work weekends, holidays, and evening hours in a 24/7 operation
Ability to perform close inspection of handwritten and computer-generated documents and PC monitor
Ability to sit for extended periods, talk on the telephone, and type on a computer
Proficiency with computer skills, navigating multiple systems, and keyboarding
Effective verbal and written communication skills

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.)