Utilization Management Nurse Consultant

CVS Health

. Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations .

Posted 11/10/2026full-timeRemote • Kentucky • United StatesJuniorMid-Level💰 $26 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong clinical assessment, critical thinking, and decision-making skills while effectively collaborating with healthcare providers and care teams. Proficient in navigating multiple computer systems and applications to support utilization management and improve member outcomes.

Highest-signal resume keywords

Active RN License2+ Years Adult Acute Care ExperienceClinical Assessment SkillsUtilization Management ExperienceMicrosoft Office 365 Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCritical ThinkingDecision-MakingMultitaskingHealthcare UtilizationCare CoordinationQuality ImprovementEHR NavigationTroubleshooting Technical IssuesHIPAA Compliance

Soft Skills

Verbal CommunicationWritten CommunicationCollaborationAdaptabilityTime Management

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNEHR PortalsTeams Messaging

Certifications & Qualifications

Active RN LicenseAssociate Degree in Nursing

Industry Keywords

Utilization ManagementManaged CareAdult Acute CareCritical Care NursingMed-Surg Nursing

About the role

Key responsibilities & impact

Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations
Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care
Collaborate with providers and care teams to facilitate appropriate treatment and care planning
Identify opportunities to improve quality of care, member outcomes, and healthcare utilization
Connect members with additional programs and resources that support their healthcare needs
Serve as a clinical resource for internal and external stakeholders
Work within a 24/7 Utilization Management operation
Collaborate frequently with providers, members, and interdisciplinary healthcare teams
Meet productivity and quality expectations in a remote, computer-based position
Work schedules that may include evenings, weekends, and holidays

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of adult acute care and/or critical care nursing experience
Strong clinical assessment, critical thinking, and decision-making skills
Excellent verbal and written communication skills
Ability to multitask and work effectively in a fast-paced environment
Proficiency navigating multiple computer systems and applications
Associate Degree in Nursing required
2+ years of Med-Surg or specialty nursing experience preferred
Managed Care or Utilization Management experience preferred
Residence in the Eastern 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 virtual work location compliant with CVS Health and HIPAA guidelines
Ability to work within the state and city where currently living
Ability to provide workspace furniture, such as a desk or standing desk
Ability to use multiple monitors and navigate multiple applications simultaneously
Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace applications
Ability to log in to secure systems such as VPN and EHR portals
Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links
Ability to troubleshoot common technical issues independently
Openness to learning new skills as the workplace environment 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
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
Remote work from home
Opportunities to expand knowledge of Utilization Management and Managed Care