Utilization Management Nurse Consultant

CVS Health

. Review clinical information and apply evidence-based criteria to make coverage recommendations .

Posted 9/21/2026full-timeRemote • Illinois • United StatesJuniorMid-Level💰 $32 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in clinical assessment and evidence-based decision-making to enhance patient care and support healthcare utilization. Proficient in managing multiple priorities in a fast-paced environment while ensuring compliance with HIPAA guidelines.

Highest-signal resume keywords

Active RN License2+ Years RN Experience in Acute CareUtilization Management ExperienceMicrosoft Office 365 ProficiencyAbility to Navigate Multiple Applications

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical AssessmentEvidence-Based Criteria ApplicationCare CoordinationPatient Support ProgramsMedical-Surgical ExperienceCritical Care ExperienceTroubleshooting Technical IssuesVPN AccessEHR Portal NavigationMultitasking

Soft Skills

Strong Communication SkillsTeam CollaborationAdaptabilityProblem-Solving

Tools & Technologies

Microsoft Office 365Google WorkspaceSecure Systems AccessMultiple Monitors

Certifications & Qualifications

Active RN LicenseAssociate's Degree in NursingBSN Preferred

Industry Keywords

Managed CareUtilization ManagementPatient OutcomesHealthcare UtilizationHIPAA Compliance

About the role

Key responsibilities & impact

Review clinical information and apply evidence-based criteria to make coverage recommendations
Collaborate with healthcare providers and internal teams to support quality patient outcomes
Identify opportunities for care coordination and member support programs
Promote effective healthcare utilization and contribute to high-quality service delivery
Manage multiple systems and priorities in a fast-paced, team-oriented environment
Support members in navigating their healthcare journey
Work scheduled shifts that may include evenings, weekends, and holidays as part of a 24/7 operation

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
Minimum 2 years of RN experience in an adult acute care or critical care setting
Associate's Degree in Nursing
Strong communication, computer, and multitasking skills
Ability to work schedules that may include evenings, weekends, and holidays as part of a 24/7 operation
Previous Managed Care and/or Utilization Management experience preferred
2+ years of clinical experience in Medical-Surgical or specialty care preferred
BSN preferred
Candidates located in Central Time Zone preferred
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
Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently living
Ability to use multiple monitors and navigate multiple applications
Experience with Microsoft Office 365 applications or similar tools such as Google Workspace
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

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.)