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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 secure systems to support care coordination in a non-bedside role.
Highest-signal resume keywords
Active RN License3+ Years RN ExperienceClinical Assessment SkillsMicrosoft Office ProficiencyEHR Portal Access
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 JudgmentUtilization ManagementCare CoordinationEvidence-Based GuidelinesTechnical Troubleshooting
Soft Skills
CollaborationOpenness to Learning
Tools & Technologies
Microsoft Office 365Google WorkspaceVPN Access
Certifications & Qualifications
Associate Degree in NursingBSN Preferred
Industry Keywords
Med/Surg ExperienceHIPAA ComplianceHealthcare Quality
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 utilization and benefit management decisions
- Identify opportunities to improve care quality and member outcomes
- Serve as a clinical resource for internal and external stakeholders
- Transition clinical expertise into a collaborative, non-bedside role
- Support care coordination and healthcare quality for members
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–6:00 PM in your time zone; schedules may include holidays and evening hours
- Associate Degree in Nursing
- Direct/hardwired internet connection within 7 feet of the modem/router
- 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
- Ability to use multiple monitors and applications simultaneously
- Ability to use digital communication channels and virtual meetings
- Experience with Microsoft Office 365 or similar Google Workspace applications
- Ability to access secure systems such as VPN and EHR portals
- Ability to follow computer and password security practices and recognize suspicious emails or links
- Ability to troubleshoot common technical issues independently
- Openness to learning new skills
- BSN preferred
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical, dental, and 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