Utilization Management Nurse Consultant

CVS Health

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

Posted 10/28/2026full-timeRemote • United StatesJuniorMid-Level💰 $26 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in clinical assessment, care coordination, and utilization management within a healthcare setting. Proficient in navigating electronic health records and utilizing Microsoft Office 365 for effective communication and documentation.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceClinical Assessment SkillsEffective Communication SkillsProficiency in Microsoft Office 365

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCare CoordinationUtilization ManagementMed Surg ExperienceCritical Care ExperienceKeyboarding SkillsTechnical TroubleshootingEHR NavigationClinical JudgmentPolicy Application

Soft Skills

Effective Verbal CommunicationEffective Written CommunicationMultitaskingAdaptabilityPrioritization

Tools & Technologies

Microsoft Office 365VPNEHR PortalsTeams MessagingVirtual Meeting Platforms

Certifications & Qualifications

Active RN LicensureAssociates Degree

Industry Keywords

Healthcare ServicesBenefit ManagementClinical GuidelinesHIPAA ComplianceManaged Care

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 in coordinating and administering 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, 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 an adult acute care/critical care setting
Active, current and unrestricted RN licensure in the state of residence
Associates Degree required
2+ years of clinical experience in med surg or a specialty area
Managed Care experience preferred, especially Utilization Management
Preference for candidates residing in PST zones
Proficiency with computer skills, navigating multiple systems and keyboarding
Effective verbal and written communication skills
Ability to work weekends, holidays, and evening hours in a 24/7 operation
Direct/hardwired internet connection to a modem/router within 7 feet of the computer, with minimum speeds 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
Ability to work within the state and city where currently living
Ability to set up and use multiple monitors and navigate multiple applications
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace applications
Ability to log in to secure systems such as VPN and EHR portals, maintain computer security, manage strong passwords, and recognize suspicious emails or links
Ability to troubleshoot common technical issues and contact IT when needed
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 (keyboard, monitor, computer, headset, etc.)