UM Nurse Consultant

CVS Health

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

Posted 11/3/2026full-timeRemote • Iowa • United StatesJuniorMid-Level💰 $26 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in clinical assessment and utilization management, with a focus on promoting quality patient outcomes and effective healthcare utilization. Proficient in navigating electronic health records and utilizing Microsoft Office 365 applications in a remote work environment.

Highest-signal resume keywords

Active RN LicenseUtilization Management Experience2+ Years RN ExperienceAssociates Degree in NursingStrong Communication Skills

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 AssessmentCare CoordinationUtilization ManagementPatient Outcome ImprovementMed-Surg ExperienceCritical Care ExperienceComputer NavigationTechnical Issue ResolutionEHR Portal AccessHIPAA Compliance

Soft Skills

MultitaskingCollaborationFlexibilityOpenness to LearningEffective Communication

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNSecure SystemsMultiple Monitors

Certifications & Qualifications

Active RN LicenseBSN Preferred

Industry Keywords

Managed CareHealthcare UtilizationQuality ImprovementClinical GuidelinesCare Management

About the role

Key responsibilities & impact

Review and assess clinical information to support coverage determinations and care recommendations
Apply clinical guidelines, policies, and professional judgment across the continuum of care
Collaborate with providers and healthcare teams to facilitate quality patient outcomes
Identify opportunities for care management referrals and member support programs
Promote effective healthcare utilization and quality improvement initiatives
Perform utilization management clinical review and care coordination
Work at a desk for extended periods during remote work

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of RN experience in an adult acute care or critical care setting
Strong communication, multitasking, and computer navigation skills
Ability to work a flexible schedule, including evenings, weekends, and holidays as part of a 24/7 operation
Associates Degree in Nursing required
2+ years of Med-Surg or specialty clinical experience preferred
Managed Care and/or Utilization Management experience preferred
Candidates residing in CST/MST/PST locations preferred
BSN preferred
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 25 mbs download and 3 mbs upload
Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines
Ability to work within the state and city where currently living
Own workspace furniture, such as a desk or standing desk
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 applications or similar Google Workspace applications
Ability to log in to secure systems such as VPN and EHR portals
Ability to lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links
Ability to resolve common technical issues independently
Openness to learning new skills as the workplace environment evolves

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay range
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.)