Utilization Management, Nurse Consultant

CVS Health

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

Posted 11/10/2026full-timeRemote • United StatesJuniorMid-Level💰 $32 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment, care coordination, and utilization management within a fast-paced healthcare environment. Proficient in leveraging technology for communication and documentation while ensuring compliance with healthcare regulations.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceClinical Assessment SkillsMicrosoft Office 365 ProficiencyManaged Care Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical JudgmentCoverage DeterminationHealthcare Services CoordinationEHR NavigationTechnical Issue ResolutionMultitaskingDocument InspectionPatient Referral IdentificationQuality Effectiveness PromotionAdult Acute Care Experience

Soft Skills

Effective CommunicationAdaptabilityPrioritizationCollaborationProblem-Solving

Tools & Technologies

Microsoft TeamsMicrosoft OutlookMicrosoft WordMicrosoft ExcelMicrosoft PowerPointVPN AccessSecure Systems LoginGoogle Workspace

Certifications & Qualifications

Active RN LicensureAssociates Degree

Industry Keywords

Managed CareUtilization ManagementHIPAA ComplianceClinical GuidelinesHealthcare BenefitsAdult Acute CareCritical CareMed Surg ExperienceTelehealth CommunicationHome Work Location Compliance

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, and programs
Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization
Consult and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management
Work in a 24/7 operation with weekends, holidays, and evening hours
Perform close inspection of handwritten and computer-generated documents and PC monitors
Sit for extended periods, talk on the telephone, and type on the 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
Must have active current and unrestricted RN licensure in state of residence
Ability to work weekends, holidays, and evening hours
Ability to set up and use multiple monitors and navigate multiple applications simultaneously
Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace)
Ability to log in to secure systems such as VPN and EHR portals
Ability to manage strong passwords and recognize suspicious emails or links
Ability to resolve common technical issues independently
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 50 Mbps download and 5 Mbps upload
Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently residing
Associates Degree required
Managed Care experience preferred, especially Utilization Management
2+ years of clinical experience in med surg or specialty area
Preference for candidates residing in Eastern zones

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to the base pay range
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.)