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Utilization Management Nurse Consultant
CVS Health. Review clinical cases and make coverage determinations using evidence-based guidelines .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong clinical assessment and decision-making skills, with a focus on care coordination and healthcare quality. Proficient in utilizing Microsoft Office applications and navigating secure systems while maintaining compliance with HIPAA guidelines.
Highest-signal resume keywords
Active RN License3+ Years RN ExperienceClinical Assessment SkillsMicrosoft Office ProficiencyCare Coordination
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical JudgmentUtilization ManagementEvidence-Based GuidelinesCare Quality ImprovementDecision-Making
Soft Skills
CollaborationCommunicationOpenness to Learning
Tools & Technologies
Microsoft Office 365EHR PortalsVPNDigital Communication Channels
Certifications & Qualifications
RN License
Industry Keywords
Med/Surg ExperienceHIPAA ComplianceHealthcare QualityCare TeamsRemote Work
About the role
Key responsibilities & impact- Review clinical cases and make coverage determinations using evidence-based guidelines
- Collaborate with providers and care teams to coordinate appropriate treatment
- Apply clinical judgment to support utilization and benefit management decisions
- Identify opportunities to improve care quality and member outcomes
- Serve as a clinical resource across internal and external stakeholders
- Transition clinical skills into a collaborative, non-bedside role focused on care coordination and healthcare quality
Requirements
What you’ll need- Active, unrestricted RN license in the state of residence
- 3+ years of RN experience, including 1+ year in Med/Surg
- Strong clinical assessment and decision-making skills
- Experience with Microsoft Office (Outlook, Teams, Excel)
- Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone; schedules may include holidays and evening hours
- Associate Degree in Nursing
- Direct/hardwired internet connection to a modem/router within 7 feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted
- Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines
- Must work within the state and city where currently residing
- Must provide workspace furniture, such as a desk or standing desk
- Ability to set up and use multiple monitors and navigate multiple applications
- Ability to use digital communication channels including 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, lock screens, manage strong passwords, and recognize suspicious emails or links
- Ability to troubleshoot common technical issues and contact IT when needed
- 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 (keyboard, monitor, computer, headset, etc.)
- Supportive, team-driven work environment