Utilization Management Nurse Consultant

CVS Health

. Review clinical information and apply evidence-based criteria to make coverage recommendations .

Posted 10/30/2026full-timeRemote • South Carolina • United StatesJuniorMid-Level💰 $26 - $75 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in clinical assessment and evidence-based decision-making to enhance patient care and resource utilization. Proficient in utilizing technology for communication and care coordination within a virtual environment while adhering to HIPAA guidelines.

Highest-signal resume keywords

Active RN License2+ Years RN ExperienceUtilization Management ExperienceMicrosoft Office 365 ProficiencyStrong Communication Skills

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 AssessmentEvidence-Based Criteria ApplicationCare CoordinationPatient Coverage RecommendationsMultitaskingTroubleshooting Technical IssuesEHR NavigationVPN AccessHealthcare Resource UtilizationMed-Surg Experience

Soft Skills

Strong CommunicationFlexibilityCollaborationMultitaskingProblem-Solving

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNEHR PortalsTeams Messaging

Certifications & Qualifications

Active RN LicenseBSN Preferred

Industry Keywords

Utilization ManagementManaged CareHIPAA ComplianceAcute CareCritical Care

About the role

Key responsibilities & impact

Review clinical information and apply evidence-based criteria to make coverage recommendations
Collaborate with providers and interdisciplinary teams to support care coordination
Identify opportunities to improve quality, outcomes, and healthcare resource utilization
Refer members to appropriate programs and services that support their healthcare needs
Serve as a clinical resource for internal and external stakeholders
Support a 24/7 Utilization Management team
Help ensure members receive the right care at the right time

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of RN experience in an adult acute care or critical care setting
Associate Degree in Nursing (ADN)
Strong communication, multitasking, and computer skills
Ability to work a flexible schedule, including evenings, weekends, and holidays
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 25 mbs download and 3 mbs upload
Quiet, secure and 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 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 maintain computer security, manage strong passwords, and recognize suspicious emails or links
Ability to troubleshoot common technical issues independently
BSN preferred
2+ years of Med-Surg or specialty clinical experience preferred
Utilization Management and/or Managed Care experience preferred
Eastern Time Zone candidates 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.)
Opportunity for professional growth and learning new skills