Utilization Management Nurse Consultant

CVS Health

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

Posted 10/16/2026full-timeRemote • Illinois • United StatesJuniorMid-Level💰 $26 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare services coordination, clinical assessment, and utilization management while ensuring compliance with HIPAA guidelines. Proficient in leveraging technology for effective communication and documentation in a virtual work environment.

Highest-signal resume keywords

Registered Nurse (RN) Licensure2+ Years Experience in Adult Acute CareMicrosoft Office 365 ProficiencyClinical Criteria ApplicationUtilization Management Expertise

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCoverage DeterminationHealthcare Services CoordinationDocument InspectionKeyboarding SkillsVPN AccessEHR Portal NavigationTechnical Issue ResolutionInternet Speed ManagementMultitasking

Soft Skills

CommunicationAdaptabilityPrioritizationCollaborationOpenness to Learning

Tools & Technologies

Microsoft Office 365Google WorkspaceEmail SystemsTeams MessagingVirtual Meeting Platforms

Certifications & Qualifications

Active Registered Nurse (RN) Licensure

Industry Keywords

Healthcare ServicesUtilization ManagementHIPAA ComplianceAcute CareCritical Care

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 judgment to render coverage determinations or recommendations
Communicate with providers and other parties to facilitate care and treatment
Identify members for referral opportunities to other products, services, and programs
Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
Consult and provide expertise to internal and external constituents in utilization and benefit management
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
Contact IT for unresolved technical issues

Requirements

What you’ll need

Must reside in Central Time, Mountain Time, or Pacific Time zones
Active current and unrestricted Registered Nurse (RN) licensure in state of residence
2+ years of experience as a Registered Nurse in adult acute care/critical care setting
Availability to work weekends, holidays, and evening hours as required
Associates Degree in Nursing or Nursing Diploma (Required)
Direct/hardwired internet connection to modem/router within 7 feet of 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
Proficiency with computer skills, multiple systems, keyboarding, multiple monitors, and multiple applications
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace
Ability to log in to secure systems such as VPN and EHR portals
Ability to manage strong passwords and recognize suspicious emails or links
Ability to resolve 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 including keyboard, monitor, computer, and headset
Remote work from home