Utilization Management Nurse Consultant

CVS Health

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

Posted 11/4/2026full-timeRemote • Alabama • 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 Utilization Management and clinical assessment, with a strong focus on effective communication and coordination of healthcare services. Proficient in navigating multiple systems and applications while maintaining compliance with HIPAA guidelines.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceClinical Assessment SkillsMicrosoft Office 365 ProficiencyEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ExperienceHealthcare Services CoordinationCoverage DeterminationClinical Criteria ApplicationTechnical Issue TroubleshootingMultitaskingDocument InspectionKeyboarding SkillsEHR Portal NavigationVPN Access

Soft Skills

Verbal CommunicationWritten CommunicationAdaptabilityPrioritizationTeam Collaboration

Tools & Technologies

Microsoft Office 365Google WorkspaceTeams MessagingVirtual Meeting ToolsSecure Systems Access

Certifications & Qualifications

Registered Nurse LicenseAssociate or Bachelor of Science in Nursing

Industry Keywords

Utilization ManagementManaged CareHIPAA ComplianceAdult Acute 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 clinical judgment to render coverage determinations or recommendations across the continuum of care
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 healthcare service quality and effective benefit utilization
Consult and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management
Work in a 24/7 utilization management operation with possible weekends, holidays, and evening hours
Meet productivity and quality expectations in a typical office working environment
Perform close inspection of handwritten and computer-generated documents and PC monitor
Sit for extended periods, talk on the telephone, type, multitask, prioritize, and adapt to a fast-paced changing environment
Navigate multiple systems and applications and troubleshoot common technical issues

Requirements

What you’ll need

2+ years of clinical experience as a Registered Nurse in a hospital setting 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
Effective verbal and written communication skills
Proficiency with computer skills, navigating multiple systems, and keyboarding
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 CVSHealth and HIPAA guidelines
Must work within the state and city where currently living
Must provide own workspace furniture
Ability to set up and use multiple monitors and navigate multiple applications simultaneously
Ability to use 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 manage strong passwords and recognize suspicious emails or links
Ability to resolve common technical issues independently
Associate or Bachelor of Science in Nursing; BSN preferred
Preferred: 3+ years of clinical experience in adult med surg or specialty area
Managed Care experience preferred, especially Utilization Management
Preference for those residing in CST zone

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to the base pay range
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