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Utilization Management Nurse Consultant
CVS Health. Review clinical information and apply evidence-based guidelines, policies, and clinical judgment to support coverage determinations .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong clinical assessment and critical thinking skills while effectively collaborating with interdisciplinary healthcare teams to improve quality of care and member outcomes. Proficient in navigating multiple computer systems and applications to support utilization management and coverage determinations.
Highest-signal resume keywords
Active RN License2+ Years Adult Acute Care ExperienceClinical Assessment SkillsManaged Care ExperienceMicrosoft Office 365 Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Critical ThinkingClinical AssessmentUtilization ManagementHealthcare CoordinationEvidence-Based Guidelines ApplicationMultitaskingEHR NavigationTechnical Issue ResolutionQuality ImprovementCare Planning
Soft Skills
Communication SkillsCollaborationAdaptabilityProblem-SolvingTime Management
Tools & Technologies
Microsoft Office 365Google WorkspaceVPNEHR PortalsTeams Messaging
Certifications & Qualifications
Active RN LicenseAssociate Degree in NursingBSN Preferred
Industry Keywords
Healthcare ServicesMember OutcomesQuality of CareAcute Care NursingCritical Care NursingMed-Surg NursingHIPAA ComplianceVirtual Work EnvironmentCentral Time Zone Residence24/7 Operations
About the role
Key responsibilities & impact- Review clinical information and apply evidence-based guidelines, policies, and clinical judgment to support coverage determinations
- Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
- Collaborate with providers and care teams to facilitate appropriate treatment and care planning
- Identify opportunities to improve quality of care, member outcomes, and healthcare utilization
- Connect members with additional programs, services, and resources when appropriate
- Serve as a clinical resource for internal and external stakeholders
- Work remotely in a computer-based role with productivity and quality expectations
- Collaborate frequently with providers, members, and interdisciplinary healthcare teams
- Work schedules that may include evenings, weekends, and holidays because Utilization Management operates 24/7
Requirements
What you’ll need- Active, unrestricted RN license in your state of residence
- 2+ years of adult acute care and/or critical care nursing experience
- Strong clinical assessment, critical thinking, and communication skills
- Ability to multitask and work effectively in a fast-paced environment
- Proficiency navigating multiple computer systems and applications
- Associate Degree in Nursing required
- 2+ years of Med-Surg or specialty nursing experience preferred
- Managed Care or Utilization Management experience preferred
- Residence in the Central Time Zone preferred
- BSN preferred
- Availability for schedules that may include evenings, weekends, and holidays
- 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 provide workspace furniture, such as a desk or standing desk
- Ability to use multiple monitors and applications simultaneously
- 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 log in to secure systems such as VPN and EHR portals
- Ability to follow computer, password, and security practices
- Ability to resolve common technical issues independently
- Openness to learning new skills as the workplace environment 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 colleagues’ and families’ physical, emotional, and financial well-being
- Company-provided equipment (keyboard, monitor, computer, headset, etc.)
- Remote work from home
- Collaborative clinical team environment
- Career growth in Utilization Management and Managed Care