Nurse Consultant, Utilization Management

CVS Health

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

Posted 11/11/2026full-timeRemote • 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 coordinating healthcare services and benefits for members. Proficient in managing care quality and effective benefit utilization while adhering to HIPAA guidelines and computer security practices.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceClinical Assessment SkillsMicrosoft Office 365 ProficiencyManaged Care Knowledge

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical JudgmentCoverage DeterminationHealthcare Service CoordinationMultitaskingKeyboarding SkillsEHR Portal AccessTechnical Issue ResolutionDocument InspectionClinical Criteria ApplicationMed Surg Experience

Soft Skills

Communication SkillsAdaptabilityPrioritizationCollaborationProblem-Solving

Tools & Technologies

Microsoft TeamsMicrosoft OutlookMicrosoft WordMicrosoft ExcelMicrosoft PowerPointGoogle WorkspaceVPN AccessSecure Systems AccessVirtual Meeting PlatformsMultiple Monitor Setup

Certifications & Qualifications

Active RN LicensureAssociate Degree

Industry Keywords

Utilization ManagementManaged CareHealthcare ServicesHIPAA ComplianceClinical GuidelinesAdult Acute CareCritical CareMed SurgBenefit ManagementProductivity Expectations

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 clinical 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, or programs
Identify opportunities to promote healthcare service quality and effective benefit utilization
Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management
Work in a 24/7 utilization management operation with weekends, holidays, and evening hours
Meet productivity and quality expectations in a typical office working environment
Perform close inspection of handwritten and computer-generated documents and PC monitors
Sit for extended periods, talk on the telephone, type, multitask, prioritize, and adapt to a fast-paced changing environment

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 the state of residence
Willingness to work weekends, holidays, and evening hours in a 24/7 operation
2+ years of clinical experience in med surg or specialty area
Managed Care experience preferred, especially Utilization Management
Preference for candidates residing in the ET zone
Associate Degree required
Proficiency with computer skills, multiple systems, and keyboarding
Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace
Ability to use multiple monitors and applications simultaneously
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Ability to access secure systems such as VPN and EHR portals
Ability to follow computer security practices, including strong passwords and recognizing suspicious emails or links
Ability to resolve common technical issues independently
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
Quiet, secure, private, designated home workspace compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently living
Must provide workspace furniture, such as a desk or standing desk
Must obtain required internet speeds and adhere to Work From Home requirements if hired

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.)