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Utilization Management Nurse Consultant
CVS HealthUtilization Management Nurse Consultant at CVS Health reviewing clinical information and ensuring members receive appropriate care. Collaborating with teams to promote quality healthcare outcomes.
Posted 7/29/2026full-timeRemote • Illinois • 🇺🇸 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, utilizing strong communication skills to collaborate effectively with interdisciplinary teams. Holds an active RN license and possesses experience in adult acute care or critical care settings.
Highest-signal resume keywords
Active RN LicenseClinical Assessment SkillsAdult Acute Care ExperienceUtilization Management ExperienceCommunication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Guidelines ApplicationCare Management ReferralsHealthcare Utilization PromotionInterdisciplinary CollaborationCritical Care ExperienceMedical-Surgical Nursing ExperienceComputer Skills
Soft Skills
Strong CommunicationAbility to Thrive in Fast-Paced Environment
Certifications & Qualifications
Associates Degree in NursingBSN Preferred
Industry Keywords
Managed CarePositive Member OutcomesQuality Healthcare
About the role
Key responsibilities & impact- Review and assess clinical information to support coverage and care decisions
- Apply clinical guidelines, policies, and professional judgment across the continuum of care
- Collaborate with providers and interdisciplinary teams to coordinate treatment and services
- Identify opportunities for care management referrals and member support programs
- Promote quality, effective healthcare utilization, and positive member outcomes
- Serve as a clinical resource for internal and external stakeholders
Requirements
What you’ll need- Active, unrestricted RN license in state of residence
- Minimum 2 years of RN experience in adult acute care or critical care
- Strong clinical assessment, communication, and computer skills
- Ability to thrive in a fast-paced, high-volume environment
- Associates Degree in Nursing
- Preferred Qualifications: Experience in Medical-Surgical or specialty nursing, Managed Care and/or Utilization Management experience, BSN preferred
Benefits
Comp & perks- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- CVS Health bonus, commission or short-term incentive program