Utilization Management Nurse Consultant

CVS Health

Utilization Management Nurse Consultant providing remote healthcare coordination and assessment for CVS Health. Collaborating to facilitate appropriate healthcare services and benefits for members, ensuring quality and efficiency.

Posted 6/16/2026full-timeRemote • Florida • 🇺🇸 United StatesMid-LevelSenior💰 $29 - $62 per hourWebsite

About the role

Key responsibilities & impact

Utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits
Gather clinical information and apply appropriate clinical criteria to render coverage determinations and recommendations
Communicate with providers to facilitate care and treatment
Identify opportunities to promote quality and effectiveness of healthcare services
Consult with constituents in the coordination and administration of the utilization/benefit management function
Meet set productivity and quality expectations as established by UMNC

Requirements

What you’ll need

Registered Nurse
Diploma RN acceptable; Associate degree / BSN preferred
3+ years of experience as a Registered Nurse
1+ years of clinical experience in acute or post-acute setting
1+ years of Utilization Management / Care Management Experience
Must have active current and unrestricted RN licensure in state of residence
Utilization Management experience preferred

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical assessmentcare coordinationcoverage determinationsclinical criteria applicationutilization managementcare managementhealthcare services evaluationproductivity expectationsquality expectations

Soft Skills

collaborationcommunicationproblem-solvingquality improvementadministration

Certifications

Registered Nurse licensureBSN