Utilization Management Nurse Consultant

CVS Health

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

Posted 11/6/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $26 - $75 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical decision-making and care coordination, with a strong focus on patient advocacy and quality outcomes. Proficient in utilizing multiple documentation platforms and systems to support effective healthcare utilization and member-centered care.

Highest-signal resume keywords

Active RN License2+ Years Registered Nurse ExperienceUtilization Management ExperienceMicrosoft Office 365 ProficiencyCritical Care Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Decision-MakingCare CoordinationEvidence-Based Criteria ApplicationPatient AdvocacyHealthcare Quality ImprovementDocumentation Platform NavigationEHR Portal AccessTechnical Issue ResolutionInternet Speed ComplianceHIPAA Compliance

Soft Skills

CollaborationCritical ThinkingCommunicationOpenness to LearningAdaptability

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNTeams MessagingVirtual Meeting Platforms

Certifications & Qualifications

Active RN LicenseAssociate Degree in NursingBachelor of Science in Nursing (Preferred)

Industry Keywords

Managed CareMed-Surg ExperienceAdult Acute CareCritical Care SettingPatient-Centered Care

About the role

Key responsibilities & impact

Review clinical information and apply evidence-based criteria to make coverage and authorization determinations
Collaborate with physicians, providers, and interdisciplinary teams to support quality patient outcomes
Identify opportunities for care coordination, case management, and other healthcare programs
Promote effective healthcare utilization and member-centered care
Serve as a clinical resource and partner for internal and external stakeholders
Work in a computer-based role using multiple systems and documentation platforms
Support patient advocacy, critical thinking, healthcare decision-making, healthcare quality, outcomes, and member experiences

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of Registered Nurse experience in an adult acute care or critical care setting
Associate Degree in Nursing (ADN)
Candidates located in the Eastern Time Zone are strongly preferred
2+ years of Med-Surg or specialty clinical experience preferred
Utilization Management or Managed Care experience preferred
BSN preferred
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
Ability to work evenings, weekends, and holidays as schedules may vary in a 24/7 operation
Ability to navigate multiple monitors, applications, systems, and documentation platforms
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace tools
Ability to log in to secure systems such as VPN and EHR portals
Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links
Ability to resolve common technical issues independently
Openness to learning new skills as the workplace environment evolves
Must work within the state and city where currently residing

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
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
Comprehensive benefits package supporting physical, emotional, and financial well-being