Utilization Management Nurse Consultant

CVS Health

. Review clinical information and apply evidence-based criteria to support coverage determinations .

Posted 11/10/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $26 - $75 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates strong clinical judgment and communication skills while applying evidence-based criteria for coverage determinations. Proficient in utilizing technology and managing multiple applications to enhance healthcare quality and member experience.

Highest-signal resume keywords

Active RN License2+ Years RN Experience in Adult Acute CareUtilization Management ExperienceMicrosoft Office 365 ProficiencyAbility to Troubleshoot Technical Issues

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 JudgmentEvidence-Based Criteria ApplicationMedical-Surgical NursingSpecialty NursingUtilization ManagementCritical Care ExperienceComputer SkillsEHR Portal AccessVPN AccessMulti-Monitor Usage

Soft Skills

CommunicationCollaborationOpenness to LearningProblem-SolvingTeamwork

Tools & Technologies

Microsoft Office 365Google WorkspaceTeams MessagingVirtual Meeting PlatformsSecure Systems Access

Certifications & Qualifications

Active RN LicenseAssociate Degree in Nursing (ADN)

Industry Keywords

Healthcare QualityMember ExperienceProductivity GoalsHIPAA ComplianceRemote Work Environment

About the role

Key responsibilities & impact

Review clinical information and apply evidence-based criteria to support coverage determinations
Collaborate with providers and interdisciplinary teams to coordinate care and optimize outcomes
Identify opportunities to improve healthcare quality, efficiency, and member experience
Connect members with additional programs and services when appropriate
Serve as a clinical resource for utilization and benefit management activities
Work in a fast-paced, team-oriented remote environment with productivity and quality goals
Participate in a 24/7 operation requiring evenings, weekends, and holidays

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of RN experience in adult acute care or critical care
Associate Degree in Nursing (ADN)
Strong clinical judgment, communication, and computer skills
Experience in Medical-Surgical or specialty nursing
Utilization Management or Managed Care experience
Candidates located in the Eastern or Central Time Zone
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
WiFi and satellite internet are not permitted
Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently living
Ability to use multiple monitors and multiple applications simultaneously
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace applications
Ability to access 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 troubleshoot common technical issues independently
Openness to learning new skills as the workplace 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
Fully remote work environment
Schedule flexibility, including evenings, weekends, and holidays