Utilization Management Nurse Consultant

CVS Health

. Assess, plan, implement, coordinate, monitor, and evaluate healthcare service and benefit options for members .

Posted 10/16/2026full-timeRemote • United StatesJuniorMid-Level💰 $26 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in healthcare service coordination, clinical assessment, and benefit management, with a strong focus on effective communication and multitasking in a fast-paced environment. Proficient in utilizing digital communication tools and navigating secure systems while adhering to HIPAA guidelines.

Highest-signal resume keywords

Registered Nurse (RN) LicenseUtilization Management ExperienceClinical Experience in Adult Acute CareMicrosoft Office 365 ProficiencyAbility to Navigate Multiple Systems

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentBenefit ManagementCoverage DeterminationsHealthcare Service CoordinationClinical Criteria ApplicationDocument InspectionTechnical TroubleshootingEHR Portal AccessMultitaskingPrioritization

Soft Skills

Effective CommunicationAdaptabilityCollaborationProblem-SolvingTime Management

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNDigital Communication ChannelsSecure Systems Access

Certifications & Qualifications

Registered Nurse (RN) LicenseAssociates Degree in NursingBachelors Degree in Nursing (Preferred)

Industry Keywords

Healthcare Service QualityBenefit UtilizationManaged CareHIPAA ComplianceClinical Guidelines

About the role

Key responsibilities & impact

Assess, plan, implement, coordinate, monitor, and evaluate healthcare service and benefit options 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, or programs
Identify opportunities to promote healthcare service quality and effective benefit utilization
Consult and provide expertise to internal and external constituents in utilization and benefit management coordination and administration
Work in a typical office environment with productivity and quality expectations
Perform close inspection of handwritten and computer-generated documents and PC monitor content
Sit for extended periods, talk on the telephone, and type on a computer
Multitask, prioritize, and adapt to a fast-paced changing environment

Requirements

What you’ll need

Active and unrestricted Registered Nurse (RN) license in the candidate’s state of residence
2+ years of experience as a Registered Nurse in an adult acute care/critical care setting
Availability to work weekends, holidays, and evening hours as required
Associates Degree in Nursing (REQUIRED)
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 virtual work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently residing
Ability to navigate multiple systems and applications simultaneously
Ability to use digital communication channels including email, calendar invites, Teams messaging, 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
Bachelors Degree in Nursing (PREFERRED)
2+ years of clinical experience in med surg or specialty area
Managed care or Utilization Management experience preferred
Preference for candidates residing in EST zones

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.)
Remote work from a designated home workspace