Utilization Management Nurse Consultant

CVS Health

. Review clinical information and authorize services based on established criteria and guidelines .

Posted 10/7/2026full-timeRemote • Oklahoma • United StatesJuniorMid-Level💰 $26 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Review and Care Management, ensuring compliance with regulatory standards while effectively coordinating patient care and discharge planning. Proficient in digital communication and Microsoft Office 365 applications, with a strong focus on critical thinking and problem-solving in a remote work environment.

Highest-signal resume keywords

Active RN License in OklahomaUtilization Review ExperienceAcute Care Hospital RN ExperienceMicrosoft Office 365 ProficiencyCritical Thinking Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewCare ManagementPatient Discharge PlanningMedical Necessity AssessmentBenefit Utilization AssessmentEHR Portal NavigationVPN AccessTechnical Issue ResolutionMultiple Monitor SetupDigital Communication

Soft Skills

Strong Communication SkillsCritical ThinkingAbility to Manage Multiple PrioritiesOpenness to Learning

Tools & Technologies

Microsoft Office 365Google WorkspaceSecure SystemsDigital Communication Channels

Certifications & Qualifications

Active RN LicenseBSN Preferred

Industry Keywords

Regulatory ComplianceManaged CareHIPAA GuidelinesAcute Care

About the role

Key responsibilities & impact

Review clinical information and authorize services based on established criteria and guidelines
Assess medical necessity and appropriate benefit utilization
Coordinate care and support safe, efficient discharge planning
Communicate with providers and healthcare teams to facilitate treatment plans
Identify opportunities for care management and quality improvement
Document and manage utilization review activities throughout the continuum of care
Work collaboratively with providers, facilities, and internal partners to ensure quality outcomes and regulatory compliance
Work Monday-Friday, generally 8:00 AM-5:00 PM CST
Participate in occasional weekend on-call coverage
Work remotely from an Oklahoma home office with no travel required

Requirements

What you’ll need

Must reside in Oklahoma
Active, unrestricted RN license in Oklahoma
Minimum 2 years of acute care hospital RN experience
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 work location compliant with CVS Health and HIPAA guidelines
Ability to work within the state and city where currently living
Must provide own workspace furniture
Comfortable setting up and using multiple monitors and navigating multiple applications
Ability to use digital communication channels including 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 evolves
BSN preferred
Utilization Review and/or Utilization Management experience preferred
Managed Care experience preferred
Strong communication and critical-thinking skills preferred
Proficiency with Microsoft Office and computer-based systems preferred
Ability to manage multiple priorities in a fast-paced environment 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.)