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Utilization Management Nurse Consultant
CVS HealthUtilization Management Nurse Consultant reviewing clinical information and coordinating healthcare services at CVS Health. Collaborating with care teams to promote quality, cost-effective healthcare outcomes.
Posted 7/29/2026full-timeRemote • Maryland • 🇺🇸 United StatesJuniorMid-Level💰 $32 - $69 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical assessment and care management, with a focus on promoting quality healthcare outcomes and effective collaboration with providers and care teams. Holds an active RN license and possesses significant experience in adult acute care or critical care settings.
Highest-signal resume keywords
Active RN License2+ Years RN ExperienceClinical Assessment SkillsCommunication SkillsCare Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
CollaborationAdaptability
Certifications & Qualifications
Associates Degree in Nursing
Industry Keywords
Utilization ManagementCoverage DeterminationsHealthcare OutcomesMember Support ProgramsClinical Resource
About the role
Key responsibilities & impact- Review and assess clinical information to support utilization and coverage determinations
- Collaborate with providers, care teams, and internal partners to facilitate appropriate treatment and care plans
- Identify opportunities for care management referrals and member support programs
- Promote quality, cost-effective healthcare outcomes
- Serve as a clinical resource for utilization and benefit management activities
Requirements
What you’ll need- Active, unrestricted RN license in state of residence
- 2+ years of RN experience in adult acute care or critical care settings
- Strong clinical assessment, communication, and computer skills
- Ability to thrive in a fast-paced, highly collaborative environment
- Associates Degree in Nursing
Benefits
Comp & perks- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Comprehensive benefits package