Utilization Management Nurse Consultant

CVS Health Careers

. Review and assess clinical information to support coverage determinations and care decisions .

Posted 11/2/2026full-timeRemote • Ohio • United StatesJuniorMid-Level💰 $29 - $62 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong clinical assessment and communication skills while applying clinical guidelines and nursing judgment to support coverage determinations and care decisions. Proficient in utilizing technology and digital communication tools to coordinate care and improve healthcare quality.

Highest-signal resume keywords

Active RN License2+ Years RN ExperienceClinical Assessment SkillsMicrosoft Office 365 ProficiencyManaged Care Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentNursing JudgmentCare CoordinationUtilization ManagementEHR NavigationTechnical Issue ResolutionHIPAA ComplianceMultitaskingDigital CommunicationInternet Speed Requirements

Soft Skills

Communication SkillsFlexibilityCollaborationProblem-SolvingAdaptability

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNSecure SystemsDigital Communication Tools

Certifications & Qualifications

Active RN LicenseAssociate Degree in NursingBSN Preferred

Industry Keywords

Adult Acute CareCritical CareMed-Surg ExperienceHealthcare Quality ImprovementBenefit Utilization

About the role

Key responsibilities & impact

Review and assess clinical information to support coverage determinations and care decisions
Apply clinical guidelines, policies, and nursing judgment across the continuum of care
Collaborate with providers and interdisciplinary teams to coordinate care and treatment plans
Identify opportunities to improve healthcare quality, benefit utilization, and member outcomes
Refer members to appropriate programs and services supporting comprehensive care
Work remotely within the state and city of confirmed residence
Operate effectively across multiple monitors, applications, secure systems, and digital communication tools

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
Associate Degree in Nursing required
2+ years of RN experience in adult acute care or critical care settings
Strong clinical assessment, communication, and multitasking skills
Comfortable working in a fast-paced, technology-driven environment
Must work within the state and city where you currently live
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 use multiple monitors and navigate multiple applications
Ability to use digital communication channels, including 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 resolve common technical issues independently
Flexibility to work evenings, weekends, and holidays in a 24/7 operation
BSN preferred
2+ years of Med-Surg or specialty clinical experience preferred
Managed Care and/or Utilization Management experience 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
CVS Health bonus, commission or short-term incentive program in addition to base pay range
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
Flexible remote work environment