Utilization Management Nurse Consultant

CVS Health Careers

. Review clinical information and apply evidence-based criteria to make coverage recommendations .

Posted 11/11/2026full-timeRemote • Kansas • United StatesJuniorMid-Level💰 $26 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong clinical assessment and critical thinking skills while effectively collaborating with healthcare teams to improve member outcomes and resource utilization. Proficient in navigating multiple computer systems and utilizing technology to support patient care and communication.

Highest-signal resume keywords

Active RN License2+ Years RN Experience in Acute CareUtilization Management ExperienceClinical Assessment SkillsMicrosoft Office 365 Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCritical ThinkingEvidence-Based Criteria ApplicationMedical-Surgical NursingUtilization ManagementPatient Care CoordinationHealthcare Resource UtilizationTechnical TroubleshootingEHR Portal NavigationHIPAA Compliance

Soft Skills

Communication SkillsTeam CollaborationAdaptabilityProblem-SolvingTime Management

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNEHR PortalsTeams Messaging

Certifications & Qualifications

Active RN LicenseAssociate Degree in Nursing

Industry Keywords

Acute CareCritical CareManaged CareHealthcarePatient Outcomes

About the role

Key responsibilities & impact

Review clinical information and apply evidence-based criteria to make coverage recommendations
Collaborate with physicians, providers, and care teams to coordinate treatment and services
Identify opportunities to improve quality, outcomes, and healthcare resource utilization
Support members through referrals to additional programs and services when appropriate
Contribute to a fast-paced, team-oriented environment focused on delivering exceptional care
Influence care decisions and improve member outcomes

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of recent RN experience in adult acute care or critical care
Associate Degree in Nursing required
Experience in Medical-Surgical (Med-Surg) nursing or another specialty area preferred
Prior Utilization Management or Managed Care experience preferred
Strong clinical assessment, critical thinking, and communication skills
Ability to navigate multiple computer systems and manage competing priorities
Residence in the Central Time Zone or Mountain Time Zone preferred
Ability to work evenings, weekends, and holidays as schedules may include them
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 workspace compliant with CVS Health and HIPAA guidelines
Ability to work within the state and city where currently residing
Ability to provide workspace furniture for extended desk-based work
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 tools
Ability to log in to secure systems such as VPN and EHR portals
Ability to follow computer and password security practices and recognize suspicious emails or links
Ability to troubleshoot common technical issues and contact IT when needed
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.)
Opportunities for professional growth
CVS Health bonus, commission or short-term incentive program in addition to base pay