FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Utilization Management Nurse Consultant
CVS Health. Review clinical cases and make coverage determinations using evidence-based guidelines .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong clinical assessment and decision-making skills while effectively collaborating with providers and care teams to enhance care quality and member outcomes. Proficient in utilizing digital communication tools and managing secure systems in a remote work environment.
Highest-signal resume keywords
Active RN License3+ Years RN ExperienceUtilization Management ExperienceClinical Assessment SkillsMicrosoft Office Proficiency
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 JudgmentCare CoordinationEvidence-Based GuidelinesDecision-Making SkillsUtilization ManagementAmbulatory Surgery ExperienceMed/Surg ExperienceTroubleshooting Technical IssuesEHR Portal AccessVPN Access
Soft Skills
CollaborationOpenness to LearningCommunication
Tools & Technologies
Microsoft Office 365Google WorkspaceDigital Communication ToolsMultiple MonitorsSecure Systems
Certifications & Qualifications
Active RN LicenseAssociate Degree in NursingBSN Preferred
Industry Keywords
Managed CarePrior AuthorizationHIPAA ComplianceCare QualityMember Outcomes
About the role
Key responsibilities & impact- Review clinical cases and make coverage determinations using evidence-based guidelines
- Collaborate with providers and care teams to coordinate appropriate treatment
- Apply clinical judgment to support utilization and benefit management decisions
- Identify opportunities to improve care quality and member outcomes
- Serve as a clinical resource across internal and external stakeholders
- Transition clinical skills into a collaborative, non-bedside role
- Support care coordination and healthcare quality
Requirements
What you’ll need- Active, unrestricted RN license in the state of residence
- 3+ years of RN experience, including 1+ year in Med/Surg
- Strong clinical assessment and decision-making skills
- Experience with Microsoft Office, including Outlook, Teams, and Excel
- Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone
- Work schedules may include holidays and evening hours because Utilization Management is a 24/7 operation
- Associate Degree in Nursing
- 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 workspace compliant with CVS Health and HIPAA guidelines
- Must work within the state and city where currently residing
- Must provide workspace furniture, such as a desk or standing desk
- Ability to use multiple monitors and navigate multiple applications
- Ability to use digital communication tools, email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 applications or similar Google Workspace applications
- Ability to access 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 troubleshoot common technical issues and contact IT for unresolved issues
- Openness to learning new skills as the workplace evolves
- Utilization Management or Prior Authorization experience, managed care background, familiarity with MedCompass, and ambulatory surgery experience are nice to have
- 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, including keyboard, monitor, computer, and headset
- Remote work arrangement