Utilization Management Nurse Consultant

CVS Health

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

Posted 10/2/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $29 - $62 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Utilization Management and clinical assessment, with a strong focus on coordinating healthcare services and benefits for members. Proficient in effective communication and collaboration with providers and internal teams to enhance quality and effectiveness of care.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceClinical Assessment SkillsEffective Communication SkillsComputer Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Criteria ApplicationCoverage DeterminationHealthcare Service CoordinationClinical JudgmentMed Surg ExperienceCritical Care ExperienceMultitaskingPrioritizationAdaptabilityKeyboarding Skills

Soft Skills

Verbal CommunicationWritten CommunicationListening Skills

Certifications & Qualifications

Active RN LicensureAssociates DegreeBSN Preferred

Industry Keywords

Managed CareHealthcare ServicesBenefit ManagementQuality ImprovementProductivity Expectations

About the role

Key responsibilities & impact

Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members
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, and programs
Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management
Work in a typical office environment with productivity and quality expectations
Perform sedentary work involving extended periods of sitting, telephone communication, listening, and computer typing

Requirements

What you’ll need

2+ years of experience as a Registered Nurse in adult acute care/critical care setting
Must have active current and unrestricted RN licensure in state of residence
Utilization Management work schedules include weekends, holidays, and evening hours
2+ years of clinical experience in med surg or specialty area
Managed Care experience preferred, especially Utilization Management
Preference for those residing in EST zones
Associates Degree required
BSN preferred
Proficiency with computer skills, including navigating multiple systems and keyboarding
Effective verbal and written communication skills
Ability to perform close inspection of handwritten and computer-generated documents and PC monitor
Ability to multitask, prioritize, and adapt to a fast-paced changing environment

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, based on eligibility