Utilization Management Nurse Consultant

CVS Health

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

Posted 11/11/2026full-timeRemote • Illinois • United StatesJuniorMid-Level💰 $32 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management and clinical assessment, leveraging strong communication skills to coordinate healthcare services effectively. Proficient in navigating multiple computer systems and applications while adhering to HIPAA guidelines in a remote work environment.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceClinical Assessment SkillsMicrosoft Office 365 ProficiencyEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentUtilization ManagementHealthcare Services CoordinationMultitaskingKeyboardingTechnical Issue ResolutionEHR NavigationClinical Criteria ApplicationQuality ImprovementBenefit Management

Soft Skills

Effective Verbal CommunicationEffective Written CommunicationAdaptabilityPrioritization

Tools & Technologies

Microsoft Office 365VPNEHR PortalsTeamsOutlookWordExcelPowerPointGoogle WorkspaceSecure Computer Systems

Certifications & Qualifications

Active RN LicensureAssociates Degree

Industry Keywords

Managed CareAdult Acute CareCritical CareMed SurgHIPAA ComplianceHealthcare BenefitsClinical GuidelinesProductivity ExpectationsHome Office EnvironmentCST Zone Preference

About the role

Key responsibilities & impact

Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits
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 quality and effective healthcare services and benefit utilization
Consult with and provide expertise to internal and external constituents regarding utilization and benefit management
Work a schedule including weekdays, weekends, holidays, and evening hours in a 24/7 utilization management operation
Perform work in a home office environment with productivity and quality expectations
Inspect handwritten and computer-generated documents and computer monitors
Sit for extended periods, talk on the telephone, type, and navigate multiple computer systems

Requirements

What you’ll need

2+ years of experience as a Registered Nurse in an adult acute care/critical care setting
Active, current, and unrestricted RN licensure in the state of residence
Associates Degree required
2+ years of clinical experience in med surg or a specialty area
Managed Care experience preferred, especially Utilization Management
Preference for those residing in CST zones
Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously
Ability to communicate via 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, secure computers, manage strong passwords, and recognize suspicious emails or links
Ability to independently resolve common technical issues
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 50 Mbps download and 5 Mbps upload
Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently residing
Ability to obtain required internet speeds and adhere to all work-from-home requirements
Effective verbal and written communication skills
Computer proficiency, keyboarding, multitasking, prioritization, and adaptability

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to the base pay range
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.)
Remote work from home