Utilization Management Nurse Consultant

Lifelancer

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

Posted 10/14/2026full-timeRemote • Illinois • United StatesJuniorMid-Level💰 $32 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management and clinical assessment, with a strong focus on effective communication and coordination of healthcare services. Proficient in navigating multiple systems and ensuring compliance with healthcare guidelines and regulations.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceClinical Assessment SkillsMicrosoft Office 365 ProficiencyEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ExperienceCoverage DeterminationHealthcare Services CoordinationClinical Criteria ApplicationEHR Portal UsageTechnical TroubleshootingKeyboarding ProficiencyProductivity Expectations Management

Soft Skills

Verbal CommunicationWritten CommunicationOpenness to Learning

Tools & Technologies

VPNEHR PortalsMicrosoft Office 365

Certifications & Qualifications

Active RN Licensure

Industry Keywords

Managed CareHIPAA ComplianceAdult Acute CareCritical CareMed Surg

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 coordinating and administering utilization and benefit management
Work within a 24/7 utilization management operation, including possible weekends, holidays and evening hours
Perform work involving prolonged sitting, telephone communication, computer use and close inspection of documents and monitors
Navigate multiple applications and systems while meeting productivity and quality expectations

Requirements

What you’ll need

2+ years of clinical experience as a Registered Nurse in a hospital setting in adult acute care/critical care
Active, current and unrestricted RN licensure in state of residence
Associate or Bachelor of Science in Nursing (BSN preferred)
Preferred: 3+ years of clinical experience in adult med surg or specialty area
Managed Care experience preferred, especially Utilization Management
Preference for candidates residing in the CST zone
Direct/hardwired internet connection to modem/router within 7 feet of computer
Minimum internet speed of 25 Mbps download and 3 Mbps upload
WiFi and satellite internet are not permitted
Quiet, secure and private designated home workspace compliant with CVS Health and HIPAA guidelines
Ability to work within the state and city where currently residing
Proficiency navigating multiple systems and keyboarding
Effective verbal and written communication skills
Experience or ability to use Microsoft Office 365 or similar productivity applications
Ability to use secure systems such as VPN and EHR portals
Ability to manage strong passwords and recognize suspicious emails or links
Ability to troubleshoot common technical issues and contact IT when necessary
Openness to learning new workplace skills

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
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
CVS Health bonus, commission or short-term incentive program in addition to base pay
Flexible work-from-home arrangement