Utilization Management Nurse Consultant

CVS Health

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

Posted 10/8/2026full-timeRemote • Illinois • United StatesJuniorMid-Level💰 $32 - $69 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 benefit management while ensuring compliance with healthcare guidelines and regulations. Proficient in utilizing technology for effective communication and documentation in a remote work environment.

Highest-signal resume keywords

Registered Nurse LicensureClinical Experience in Adult Acute CareMicrosoft Office 365 ProficiencyEffective Communication SkillsUtilization Management Expertise

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical AssessmentCare CoordinationBenefit ManagementCoverage DeterminationClinical JudgmentEHR NavigationTechnical Issue ResolutionKeyboarding ProficiencyDocument InspectionMultitasking

Soft Skills

Effective Verbal CommunicationWritten CommunicationAdaptabilityPrioritizationTeam Collaboration

Tools & Technologies

Microsoft TeamsMicrosoft OutlookMicrosoft WordMicrosoft ExcelMicrosoft PowerPointVPN AccessEHR Portals

Certifications & Qualifications

Active RN LicensureBSN Preferred

Industry Keywords

Healthcare ServicesBenefit UtilizationHIPAA ComplianceClinical GuidelinesAcute 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, and type on a computer
Multitask, prioritize, and adapt to a fast-paced, changing environment

Requirements

What you’ll need

2+ years of clinical experience as a Registered Nurse in a hospital setting in adult acute care/critical care setting
Active, current and unrestricted RN licensure in state of residence
Ability to work weekends, holidays, and evening hours in a 24/7 operation
Proficiency with computer skills, including navigating multiple systems and keyboarding
Effective verbal and written communication skills
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, private designated home virtual work location compliant with CVSHealth 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 obtain required internet speeds and follow Work From Home requirements
Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace applications
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 and contact IT when necessary
Associate or Bachelor of Science in Nursing (BSN preferred)

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.)
Comprehensive benefits package for eligible full-time colleagues