Utilization Management Nurse Consultant

CVS Health

. Review and assess clinical information to support coverage determinations and care recommendations .

Posted 9/21/2026full-timeRemote • Connecticut • United StatesJuniorMid-Level💰 $32 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment and utilization management, applying clinical guidelines and professional judgment to support care recommendations. Proficient in navigating multiple computer systems and tools while ensuring compliance with HIPAA and security protocols in a remote work environment.

Highest-signal resume keywords

Active RN License2+ Years RN Experience in Acute CareUtilization Management ExperienceProficiency in Microsoft Office 365Critical Thinking Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentUtilization ManagementCare CoordinationMultitaskingTechnical TroubleshootingEHR NavigationInternet Speed ComplianceHIPAA ComplianceCare Management ReferralsQuality Outcomes Promotion

Soft Skills

Strong CommunicationCollaborationOpenness to Learning

Tools & Technologies

Microsoft Office 365VPNEHR PortalsTeamsVirtual Meeting Platforms

Certifications & Qualifications

Active RN LicenseAssociate Degree in Nursing

Industry Keywords

Adult Acute CareCritical CareManaged CareMed-Surg ExperienceHealthcare Utilization

About the role

Key responsibilities & impact

Review and assess clinical information to support coverage determinations and care recommendations
Apply clinical guidelines, policies, and professional judgment to utilization management decisions
Collaborate with providers and interdisciplinary teams to coordinate care and treatment plans
Identify opportunities for care management referrals and enhanced member support services
Promote quality outcomes, effective healthcare utilization, and member-centered care
Serve as a clinical resource for internal and external stakeholders
Work a 24/7 operation schedule including evenings, weekends, and holidays
Work from a designated home workspace and comply with work-from-home, security, and HIPAA requirements
Set up and use multiple monitors and applications
Communicate via email, calendar invites, Teams, and virtual meetings
Troubleshoot common technical issues and contact IT for unresolved issues

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 settings
Associate Degree in Nursing (ADN)
Strong communication, critical thinking, and multitasking skills
Proficiency navigating multiple computer systems in a high-volume environment
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 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 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 applications
Ability to log in to secure systems such as VPN and EHR portals
Ability to follow computer and password security practices and recognize suspicious emails or links
Ability to resolve common technical issues independently
Openness to learning new skills as the workplace environment evolves
Preferred: 2+ years of Med-Surg or specialty clinical experience
Preferred: Utilization Management or Managed Care experience
BSN preferred
Candidates located in Eastern or Central Time Zones preferred
Qualified applicants with arrest or conviction records will be considered in accordance with applicable federal, state, and local laws

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.)