Utilization Management Nurse Consultant – Weekends

CVS Health Careers

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

Posted 11/9/2026full-timeRemote • Georgia • United StatesMid-LevelSenior💰 $26 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management and Prior Authorization processes, with a strong focus on clinical assessment and coordination of healthcare services. Proficient in applying clinical criteria and guidelines to ensure effective benefit utilization and quality care.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceMedicare ExperienceClinical Assessment SkillsMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCoverage DeterminationBenefit ManagementMed/Surg ExperiencePrior AuthorizationUtilization ManagementAmbulatory Surgery ExperienceClinical JudgmentHealthcare Services CoordinationQuality Effectiveness Promotion

Soft Skills

Communication SkillsInterpersonal SkillsOrganizational SkillsProblem-Solving SkillsTeam Collaboration

Tools & Technologies

Microsoft OfficeMedCompass

Certifications & Qualifications

Active RN LicensureAssociates Degree

Industry Keywords

Managed CareMedicareHealthcare ServicesClinical GuidelinesUtilization Management Operation

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 appropriate clinical criteria, guidelines, policies, procedures and clinical judgment to render coverage determinations or recommendations
Communicate with providers and other parties to facilitate care and treatment
Identify members for referral opportunities integrating other products, services and programs
Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization
Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management
Work within a 24/7 utilization management operation, including holidays and evening hours

Requirements

What you’ll need

3+ years of experience as a Registered Nurse
Active, current and unrestricted RN licensure in state of residence
1+ years of Med/Surg experience
1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)
Willingness and ability to work Saturday, Sunday, Monday and Tuesday 10-hour shifts after approximately 4–5 months of training
Willingness to work occasional holiday rotations
Associates degree required
Prior Authorization or Utilization Management experience preferred
Managed care experience preferred
Experience using MedCompass preferred
Ambulatory surgery experience preferred
Medicare experience is a must

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