Utilization Management Nurse Consultant

CVS Health

. Review clinical information and apply evidence-based criteria to make coverage recommendations .

Posted 9/17/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $29 - $62 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong clinical judgment and communication skills while coordinating care and advocating for patients. Proficient in utilizing multiple computer systems and digital communication tools to enhance healthcare quality and outcomes.

Highest-signal resume keywords

Active RN License2+ Years RN ExperienceUtilization Management ExperienceMicrosoft Office 365 ProficiencyStrong Clinical Judgment

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Information ReviewEvidence-Based Criteria ApplicationCare CoordinationPatient AdvocacyHealthcare Decision SupportMultitaskingTroubleshooting Technical IssuesNavigating EHR PortalsComputer Security PracticesInternet Speed Compliance

Soft Skills

Communication SkillsCollaborationAdaptabilityProblem-Solving

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNEHR PortalsDigital Communication Tools

Certifications & Qualifications

RN LicenseAssociate’s Degree in NursingBSN Preferred

Industry Keywords

Utilization ManagementManaged CareHealthcare QualityPatient CareInterdisciplinary Teams

About the role

Key responsibilities & impact

Review clinical information and apply evidence-based criteria to make coverage recommendations
Collaborate with providers and interdisciplinary teams to support member care
Identify opportunities to improve healthcare quality, outcomes, and benefit utilization
Coordinate referrals to additional programs and services that support member needs
Serve as a clinical resource for internal and external stakeholders
Support Utilization Management operations in a fast-paced, collaborative environment
Combine patient advocacy, care coordination, and healthcare decision support to help members receive appropriate care

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of RN experience in adult acute care, critical care, medical-surgical, or specialty settings
Strong clinical judgment, communication, and multitasking skills
Ability to work efficiently across multiple computer systems in a productivity-driven environment
Associate’s Degree in Nursing
Residence in the Eastern Time Zone preferred
Utilization Management or Managed Care experience preferred
BSN preferred
Ability to work evenings, weekends, and holidays as schedules may include them
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 living
Ability to use multiple monitors and navigate multiple applications simultaneously
Ability to use digital communication tools such as email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace tools
Ability to log in to 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 troubleshoot 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
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.)
Remote work from home