Utilization Management Nurse Consultant – EST

CVS Health

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

Posted 10/16/2026full-timeRemote • United StatesJuniorMid-Level💰 $26 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare service coordination, clinical assessment, and effective communication with providers and members. Proficient in utilizing technology for remote work while adhering to HIPAA guidelines and ensuring quality care delivery.

Highest-signal resume keywords

Registered Nurse (RN) License2+ Years Experience in Adult Acute CareClinical Criteria ApplicationMicrosoft Office 365 ProficiencyEffective Verbal and Written Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCoverage DeterminationDocument InspectionMultitaskingKeyboarding ProficiencyTechnical TroubleshootingEHR Portal AccessVPN UsageBenefit Management CoordinationHealthcare Service Quality Promotion

Soft Skills

Effective CommunicationAdaptabilityPrioritizationCollaborationAttention to Detail

Tools & Technologies

Microsoft Office 365Google WorkspaceTeams MessagingVirtual Meeting PlatformsSecure Systems Access

Certifications & Qualifications

Active Registered Nurse (RN) LicenseAssociates Degree in Nursing

Industry Keywords

Healthcare ServicesHIPAA ComplianceUtilization ManagementClinical GuidelinesAcute CareCritical CareBenefit UtilizationRemote Work EnvironmentProductivity ExpectationsQuality Assurance

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
Communicate with providers and other parties to facilitate care and treatment
Identify members for referral opportunities involving other products, services, or programs
Identify opportunities to promote healthcare service quality, effectiveness, and benefit utilization
Consult with internal and external constituents regarding utilization and benefit management coordination and administration
Work in a typical office environment with productivity and quality expectations while working remotely
Perform close inspection of handwritten and computer-generated documents and PC monitors
Work sedentary hours involving extended sitting, telephone communication, and computer typing

Requirements

What you’ll need

Candidate must reside in EST zones
Active and unrestricted Registered Nurse (RN) license in the 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 (REQUIRED)
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 workspace compliant with CVS Health and HIPAA guidelines
Ability to work within the state and city where currently residing
Computer proficiency, including multiple systems and keyboarding
Effective verbal and written communication skills
Ability to inspect handwritten and computer-generated documents and PC monitors closely
Ability to sit for extended periods, talk on the telephone, type, multitask, prioritize, and adapt to a fast-paced changing environment
Comfort setting up and using multiple monitors and navigating multiple applications
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace tools
Ability to access secure systems such as VPN and EHR portals, secure devices, manage strong passwords, 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
Remote work from home
Company-provided equipment including keyboard, monitor, computer, and headset