Nurse Consultant – UM

CVS Health

Utilization Management Nurse Consultant supporting healthcare services for CVS Health. Assessing, planning, and coordinating healthcare services to members in a remote capacity.

Posted 7/23/2026full-timeRemote • Virginia • 🇺🇸 United StatesJuniorMid-Level💰 $26 - $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 coordinating healthcare services and effective communication with providers. Proficient in navigating multiple systems and applying clinical criteria to ensure quality care and benefit utilization.

Highest-signal resume keywords

Registered Nurse LicensureUtilization Management ExperienceClinical Assessment SkillsEffective Communication SkillsMultitasking and Prioritization

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCare CoordinationCoverage DeterminationClinical Criteria ApplicationHealthcare Services EvaluationMed Surg ExperienceCritical Care ExperienceKeyboarding ProficiencyDocument InspectionPolicy and Procedure Adherence

Soft Skills

Effective CommunicationCollaborationAdaptabilityProblem-SolvingTime Management

Tools & Technologies

PC ProficiencyMultiple Systems Navigation

Certifications & Qualifications

Active RN Licensure

Industry Keywords

Utilization ManagementManaged CareHealthcare ServicesQuality EffectivenessReferral Opportunities

About the role

Key responsibilities & impact

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
Communicates with providers and other parties to facilitate care/treatment
Identifies members for referral opportunities to integrate with other products, services and/or programs
Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
Typical office working environment with productivity and quality expectations
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor
Sedentary work involving periods of sitting, talking, listening
Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written

Requirements

What you’ll need

2+ years of experience as a Registered Nurse in adult acute care/critical care setting
Must have active current and unrestricted RN licensure in state of residence
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
2+ years of clinical experience required in med surg or specialty area preferred
Managed Care experience preferred, especially Utilization Management
Associates Degree required, BSN preferred

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package