Utilization Management Nurse Consultant – Weekends, 4-10 Hour Shifts

CVS Health

. Review and assess clinical information to support coverage determinations .

Posted 10/14/2026full-timeRemote • United StatesMid-LevelSenior💰 $26 - $62 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment and utilization management, with a strong focus on enhancing member outcomes and coordinating treatment plans. Proficient in Microsoft Office applications and capable of navigating secure systems while adhering to HIPAA guidelines.

Highest-signal resume keywords

Active RN License3+ Years RN ExperienceMed/Surg ExperienceUtilization Management ExperienceMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentUtilization ManagementTreatment Plan CoordinationQuality ImprovementPrior AuthorizationMedCompassAmbulatory Surgery KnowledgeTechnical TroubleshootingEHR NavigationComputer Security Practices

Soft Skills

CollaborationJudgmentCommunicationProblem-SolvingAdaptability

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNEHR PortalsMultiple Monitors

Certifications & Qualifications

Active RN LicenseAssociate's DegreeBSN Preferred

Industry Keywords

Managed CareClinical GuidelinesCare ContinuumCVS Health ComplianceHIPAA Guidelines

About the role

Key responsibilities & impact

Review and assess clinical information to support coverage determinations
Apply clinical guidelines, policies, and sound judgment across the care continuum
Collaborate with providers and care teams to coordinate treatment plans
Identify opportunities to enhance quality, efficiency, and member outcomes
Refer members to additional programs and services as appropriate
Serve as a clinical resource within utilization and benefit management
Complete Monday–Friday training from 8:30 AM–5:00 PM EST
Work a four-day weekend schedule from Friday through Monday with 10-hour shifts after training
Work evening hours and occasional holidays within a 24/7 operation

Requirements

What you’ll need

Active, unrestricted RN license in state of residence
3+ years of RN experience
1+ year of Med/Surg experience
Proficiency with Microsoft Office (Outlook, Teams, Excel)
Willingness to work the required schedule post-training
Prior Authorization or Utilization Management experience preferred
Managed care experience preferred
MedCompass experience preferred
Ambulatory surgery background preferred
Associate’s degree required; BSN preferred
Direct/hardwired internet connection to a modem/router within 7 feet of the computer, or ability to obtain one
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
Must work within the state and city where currently living
Ability to set up and use multiple monitors and navigate multiple applications simultaneously
Ability to use Microsoft Office 365 applications or similar Google Workspace applications
Ability to access 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 and contact IT when needed

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.)
Professional growth opportunities