Utilization Management Nurse Consultant

CVS Health

. Apply critical thinking, evidence-based clinical criteria and clinical practice guidelines to services requiring precertification .

Posted 10/2/2026full-timeRemote • Virginia • United StatesMid-LevelSenior💰 $26 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical criteria application and precertification processes, with strong proficiency in navigating multiple systems and maintaining information security. Holds active RN licensure and possesses extensive clinical experience, ensuring compliance with healthcare guidelines and effective communication in a remote work environment.

Highest-signal resume keywords

Active RN Licensure3+ Years Clinical ExperiencePrecertification ExperienceMicrosoft Office 365 ProficiencyEHR Portal Access

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Critical ThinkingClinical Practice GuidelinesComputer Security PracticesTroubleshooting Technical IssuesNavigating Multiple SystemsUsing Email and Calendar InvitesVirtual Meeting CommunicationAccessing Secure SystemsUsing Multiple MonitorsEvidence-Based Clinical Criteria

Soft Skills

Ability to Work in Fast-Paced EnvironmentOpenness to Learning New Skills

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNEHR PortalsTeams Messaging

Certifications & Qualifications

Active RN LicensureCompact RN Licensure (Preferred)

Industry Keywords

PrecertificationHIPAA ComplianceClinical ExperienceHealthcare GuidelinesRemote Work

About the role

Key responsibilities & impact

Apply critical thinking, evidence-based clinical criteria and clinical practice guidelines to services requiring precertification
Collect and review clinical information from providers by phone and computer
Use specific criteria to authorize procedures and services
Initiate Medical Director referrals when needed
Perform sedentary desk-based work involving sitting, talking, listening and computer use
Navigate multiple systems, monitors and applications to streamline tasks
Communicate through email, calendar invites, Teams and virtual meetings
Access secure systems and maintain computer and information security
Troubleshoot common technical issues and contact IT for unresolved issues

Requirements

What you’ll need

Active, current and unrestricted RN licensure in state of residence
At least an Associate’s Degree
3+ years of clinical experience in nursing
Willingness and ability to work Monday–Friday, 8 am–5 pm, with occasional weekend/holiday on-call or rotating 10-hour shifts
Proficient computer skills, including navigating multiple systems
Ability to work in a fast-paced 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
WiFi and satellite internet are not permitted
Quiet, secure and private designated home workspace compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently residing
Ability to use multiple monitors and applications simultaneously
Ability to use email, calendar invites, Teams messaging and virtual meetings
Experience with Microsoft Office 365 or similar Google Workspace applications
Ability to access secure systems such as VPN and EHR portals
Knowledge of computer security practices, including strong passwords and recognizing suspicious emails or links
Ability to troubleshoot common technical issues and contact IT when needed
Openness to learning new skills
Previous prior authorization experience preferred
Compact RN licensure preferred
BSN preferred

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
Telework/work-from-home arrangement