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Utilization Management Nurse Consultant
CVS Health. Review clinical information and authorization requests using evidence-based guidelines and established criteria .
Posted 10/6/2026full-timeRemote • Virginia • United StatesMid-LevelSenior💰 $29 - $62 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical nursing with a focus on utilization management and precertification processes, while effectively collaborating with healthcare providers and managing a high volume of cases in a remote environment.
Highest-signal resume keywords
Active COMPACT RN License3+ Years Clinical Nursing ExperienceUtilization ManagementMicrosoft Office 365EHR Portal Access
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical NursingUtilization ManagementPrecertification NursingTechnical TroubleshootingEvidence-Based Guidelines
Soft Skills
CollaborationCommunicationAdaptability
Tools & Technologies
Microsoft Office 365Google WorkspaceVPNEHR PortalsTeams Messaging
Certifications & Qualifications
Active COMPACT RN License
Industry Keywords
HIPAA ComplianceClinical Information ReviewAuthorization RequestsRemote WorkFast-Paced Environment
About the role
Key responsibilities & impact- Review clinical information and authorization requests using evidence-based guidelines and established criteria
- Collaborate with healthcare providers to gather necessary documentation
- Approve services within scope or refer complex cases to a Medical Director
- Manage a high volume of cases in a fast-paced, phone- and computer-based environment
- Perform utilization management and precertification nursing work remotely
Requirements
What you’ll need- Active, unrestricted COMPACT RN license in your state of residence
- 3+ years of clinical nursing experience
- Strong computer skills with the ability to navigate multiple systems
- Ability to work Monday-Friday, 8:00 AM-5:00 PM, with occasional weekend/holiday on-call coverage
- Associate's degree in Nursing required
- 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 CVS Health and HIPAA guidelines
- Must work within the state and city where currently living
- Must provide own workspace furniture
- Microsoft Office 365 or similar Google Workspace experience
- Ability to use multiple monitors and applications simultaneously
- Ability to use email, calendar invites, Teams messaging, and virtual meetings
- Ability to access secure systems such as VPN and EHR portals
- Ability to manage strong passwords and recognize suspicious emails or links
- Ability to troubleshoot common technical issues independently
- Openness to learning new skills as the workplace evolves
Benefits
Comp & perks- 100% remote opportunity
- Consistent schedule
- Company-provided equipment (keyboard, monitor, computer, headset, etc.)
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program eligibility