Utilization Management Nurse Consultant

CVS Health

. Review and assess clinical information to support utilization and coverage determinations .

Posted 9/18/2026full-timeRemote • Maryland • United StatesJuniorMid-Level💰 $32 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong clinical assessment and communication skills while effectively collaborating with providers and care teams to promote quality healthcare outcomes. Proficient in navigating multiple systems and utilizing digital communication tools in a remote work environment.

Highest-signal resume keywords

Active RN License2+ Years RN Experience in Adult Acute CareClinical Assessment SkillsUtilization Management ExperienceMicrosoft Office 365 Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentUtilization ManagementCare Management ReferralsEvidence-Based Criteria ApplicationTechnical Troubleshooting

Soft Skills

Strong CommunicationCollaborationAbility to MultitaskAdaptability in Fast-Paced Environments

Tools & Technologies

Microsoft Office 365VPNEHR PortalsDigital Communication Channels

Certifications & Qualifications

Active RN LicenseAssociates Degree in NursingPreferred BSN

Industry Keywords

Managed CareHealthcare OutcomesHIPAA ComplianceVirtual Work Environment

About the role

Key responsibilities & impact

Review and assess clinical information to support utilization and coverage determinations
Collaborate with providers, care teams, and internal partners to facilitate appropriate treatment and care plans
Identify opportunities for care management referrals and member support programs
Promote quality, cost-effective healthcare outcomes
Serve as a clinical resource for utilization and benefit management activities
Communicate with providers and apply evidence-based criteria and clinical judgment
Support effective, high-quality healthcare services for members
Work in a remote/office-based environment with extensive computer and telephone use
Navigate multiple systems and multitask in a sedentary desk-based role

Requirements

What you’ll need

Active, unrestricted RN license in state of residence
2+ years of RN experience in adult acute care or critical care settings
Strong clinical assessment, communication, and computer skills
Ability to thrive in a fast-paced, highly collaborative environment
Associates Degree in Nursing
Preferred: 2+ years of Med-Surg or specialty clinical experience
Preferred: Managed Care and/or Utilization Management experience
Preferred: Candidates residing in Eastern time zones
Preferred: BSN
Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 25 mbs download and 3 mbs 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 living
Ability to navigate multiple monitors and applications simultaneously
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 lock computer screens, manage strong passwords, and recognize suspicious emails or links
Ability to troubleshoot common technical issues independently
Openness to learning new skills as the workplace evolves

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.)