Utilization Management Nurse Consultant

CVS Health

. Review and assess clinical information to make coverage and care recommendations .

Posted 9/18/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $29 - $62 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment and care recommendations, applying nursing judgment and clinical guidelines to promote quality healthcare outcomes. Proficient in utilizing technology and communication tools to collaborate effectively with care teams and manage patient care in a fast-paced environment.

Highest-signal resume keywords

Active RN License2+ Years RN Experience in Adult Acute CareUtilization Management ExperienceMicrosoft Office 365 ProficiencyAbility to Navigate EHR Portals

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCare RecommendationsNursing JudgmentCare ManagementQuality Outcomes PromotionTechnical TroubleshootingMultitaskingInternet Connection ComplianceVPN AccessEHR Navigation

Soft Skills

Communication SkillsCollaborationAdaptabilityProblem-SolvingTime Management

Tools & Technologies

Microsoft Office 365Google WorkspaceTeams MessagingVirtual Meeting ToolsSecure Systems Access

Certifications & Qualifications

Active RN LicenseAssociate's Degree in NursingBSN (Preferred)

Industry Keywords

Utilization ManagementManaged CareHIPAA ComplianceAdult Acute CareCritical CareMed-Surg ExperienceEastern Time Zone Residence

About the role

Key responsibilities & impact

Review and assess clinical information to make coverage and care recommendations
Apply clinical guidelines, policies, and nursing judgment across the continuum of care
Collaborate with providers and care teams to support treatment plans
Identify opportunities for care management programs and service integration
Promote quality outcomes and effective healthcare utilization
Serve as a clinical resource for internal and external stakeholders
Work in a 24/7 operation with schedules that may include evenings, weekends, and holidays
Support Utilization Management by reviewing clinical information, coordinating care, and ensuring members receive appropriate, high-quality healthcare services

Requirements

What you’ll need

Active, unrestricted RN license in state of residence
2+ years of RN experience in adult acute care or critical care
Associate's degree in Nursing
Strong computer, communication, and multitasking skills
Ability to work in a fast-paced environment
Work schedule may include evenings, weekends, and holidays
Must have or be able to obtain a 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
WiFi and satellite internet are not permitted
Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently residing
Ability to use multiple monitors and navigate multiple applications
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace tools
Ability to access 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 independently
Preferred: 2+ years of Med-Surg or specialty clinical experience
Preferred: Utilization Management and/or Managed Care experience
Preferred: BSN
Preferred: Residence in the Eastern Time Zone

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.)