Utilization Management Nurse Consultant

CVS Health

. Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members .

Posted 10/1/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $29 - $62 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management and healthcare service quality, with a strong foundation in clinical assessment and decision-making. Proficient in navigating electronic health records and utilizing Microsoft Office 365 applications to enhance communication and productivity.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceClinical Assessment SkillsMicrosoft Office 365 ProficiencyEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical JudgmentCoverage DeterminationHealthcare Service CoordinationDocument InspectionMultitaskingTechnical TroubleshootingEHR NavigationInternet Speed ComplianceHIPAA ComplianceClinical Experience in Med Surg

Soft Skills

AdaptabilityPrioritizationVerbal CommunicationWritten CommunicationTeam Collaboration

Tools & Technologies

Microsoft Office 365Google WorkspaceVPN AccessEHR PortalsTeams Messaging

Certifications & Qualifications

Active RN LicensureAssociates Degree

Industry Keywords

Managed CareHealthcare ServicesBenefit ManagementClinical GuidelinesProductivity Expectations

About the role

Key responsibilities & impact

Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members
Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations or recommendations
Communicate with providers and other parties to facilitate care and treatment
Identify members for referral opportunities involving other products, services, or programs
Identify opportunities to promote healthcare service quality and effective benefit utilization
Consult with and provide expertise to internal and external constituents regarding utilization and benefit management
Work in a typical office environment with productivity and quality expectations
Perform close inspection of handwritten and computer-generated documents and PC monitors
Sit for extended periods, talk on the telephone, and type on a computer
Multitask, prioritize, and adapt to a fast-paced, changing environment

Requirements

What you’ll need

2+ years of experience as a Registered Nurse in adult acute care/critical care setting
Active, current, and unrestricted RN licensure in state of residence
Availability to work weekends, holidays, and evening hours in a 24/7 operation
Associates Degree required
2+ years of clinical experience in med surg or specialty area
Managed Care experience preferred, especially Utilization Management
Preference for residing in the Eastern Standard Time zone
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
Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
Ability to work within the state and city where currently living
Ability to use multiple monitors and navigate multiple applications
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 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
Effective verbal and written communication skills
Computer proficiency, including keyboarding and navigation of multiple systems

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.)