Utilization Management Nurse Consultant – Weekends

CVS Health

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

Posted 11/9/2026full-timeRemote • Georgia • United StatesMid-LevelSenior💰 $26 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in assessing and coordinating healthcare services, applying clinical criteria for coverage determinations, and effectively communicating with providers. Proficient in managing utilization and benefit management processes while promoting service quality and benefit utilization.

Highest-signal resume keywords

Registered Nurse LicensureMed/Surg ExperienceUtilization Management ExperienceMedicare ExperienceMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical AssessmentCoverage DeterminationClinical JudgmentHealthcare CoordinationBenefit Management

Soft Skills

Effective CommunicationCollaborationProblem-Solving

Tools & Technologies

Microsoft OfficeMedCompass

Certifications & Qualifications

Active RN LicensureAssociate Degree

Industry Keywords

Managed CarePrior AuthorizationAmbulatory SurgeryHealthcare ServicesClinical Guidelines

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 appropriate 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 healthcare service quality and effective benefit utilization
Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management

Requirements

What you’ll need

3+ years of experience as a Registered Nurse
Active, current and unrestricted RN licensure in state of residence
1+ years of Med/Surg experience
1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)
Willingness and ability to work Saturday, Sunday, Monday and Tuesday 10-hour shifts after approximately 4–5 months of training Monday–Friday, 7:30am–6pm EST, with occasional holiday rotation
Associate degree required
Prior Authorization or Utilization Management experience preferred
Managed care experience preferred
Experience using MedCompass preferred
Ambulatory surgery experience preferred
Medicare experience required
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