Utilization Management Nurse Consultant – Weekend Shift

CVS Health

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

Posted 10/16/2026full-timeRemote • Kentucky • United StatesMid-LevelSenior💰 $26 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in clinical assessment, care coordination, and utilization management, with a strong focus on effective communication and quality healthcare service promotion. Holds active RN licensure and possesses extensive clinical experience in a fast-paced environment.

Highest-signal resume keywords

Active RN Licensure3+ Years Clinical ExperiencePrior Authorization ExperienceEffective Communication SkillsFast-Paced Environment Adaptability

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 AssessmentCare CoordinationUtilization ManagementClinical Criteria ApplicationCoverage DeterminationDocument InspectionKeyboarding ProficiencyMultitaskingPrioritization

Soft Skills

Effective Verbal CommunicationEffective Written Communication

Certifications & Qualifications

RN Licensure

Industry Keywords

Healthcare ServicesBenefit ManagementQuality PromotionClinical GuidelinesMember Referral

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 and programs
Identify opportunities to promote quality and effective healthcare services and benefit utilization
Consult with and provide expertise to internal and external constituents in utilization and benefit management
Work two 10-hour weekend shifts and two 10-hour weekday shifts
Meet standard productivity and quality expectations
Perform close inspection of handwritten and computer-generated documents
Sit for extended periods, talk on the telephone, type, multitask and prioritize in a fast-paced environment

Requirements

What you’ll need

Ability to work a weekend position: Saturday/Sunday plus two weekdays
Active, current and unrestricted RN licensure in Kentucky or multi-state compact RN licensure
3+ years of clinical experience
Proficiency with computer skills, including navigating multiple systems and keyboarding
Ability to work in a fast-paced environment
Effective verbal and written communication skills
Associate degree required
Previous prior authorization experience preferred
BSN preferred

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program eligibility