Utilization Management Nurse Consultant

CVS Health

. Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations .

Posted 9/18/2026full-timeRemote • Kansas • United StatesJuniorMid-Level💰 $26 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong clinical assessment and critical thinking skills while effectively collaborating with healthcare providers and interdisciplinary teams to enhance patient care and outcomes. Proficient in navigating multiple computer systems and applications to support utilization management in a remote environment.

Highest-signal resume keywords

Active RN License2+ Years Acute Care ExperienceClinical Assessment SkillsMicrosoft Office 365 ProficiencyHIPAA Compliance Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical JudgmentCritical ThinkingHealthcare CoordinationUtilization ManagementEHR NavigationTechnical Issue ResolutionMultitaskingComputer Security PracticesInternet Speed ComplianceRemote Work Setup

Soft Skills

Communication SkillsCollaborationAdaptabilityProblem-SolvingTime Management

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNEHR PortalsTeams Messaging

Certifications & Qualifications

RN LicenseAssociate Degree in Nursing

Industry Keywords

Utilization ManagementHealthcare ServicesPatient CareQuality ImprovementHIPAA Guidelines

About the role

Key responsibilities & impact

Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations
Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care
Collaborate with providers and care teams to facilitate appropriate treatment and care planning
Identify opportunities to improve quality of care, health outcomes, and benefit utilization
Connect members with additional programs and resources supporting their healthcare needs
Serve as a clinical resource for internal and external stakeholders
Work in a remote, computer-based Utilization Management operation
Collaborate frequently with providers, members, and interdisciplinary healthcare teams
Work schedules that may include evenings, weekends, and holidays in a 24/7 operation

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of adult acute care and/or critical care nursing experience
Strong clinical assessment, critical thinking, and communication skills
Ability to multitask and thrive in a fast-paced environment
Proficiency navigating multiple computer systems and applications
Associate Degree in Nursing required
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 communicate through 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, 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
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 including keyboard, monitor, computer, and headset
Remote work from home