Utilization Management Nurse Consultant

CVS Health

Utilization Management Nurse Consultant coordinating clinical coverage decisions for CVS Health members. Assessing clinical information, facilitating care, and identifying referral and quality-improvement opportunities.

Posted 8/5/2026full-timeRemote • Connecticut • 🇺🇸 United StatesJuniorMid-Level💰 $32 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Utilization Management and healthcare service coordination, leveraging clinical judgment and effective communication to enhance member care and benefit utilization. Proficient in navigating multiple systems and performing detailed document inspections within a fast-paced, 24/7 operational environment.

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 AssessmentCoverage DeterminationHealthcare Service CoordinationDocument InspectionComputer Navigation

Soft Skills

Effective CommunicationAdaptabilityMultitaskingPrioritization

Certifications & Qualifications

Active RN LicensureAssociate Degree

Industry Keywords

Managed CareAdult Acute CareCritical CareMedical-Surgical ExperienceHealthcare Service Quality

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 healthcare service quality and benefit utilization
Consult and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management
Work within a 24/7 operation, including weekends, holidays and evening hours
Perform work involving document and computer-monitor inspection, telephone communication, typing and navigating multiple systems

Requirements

What you’ll need

2+ years of experience as a Registered Nurse in an adult acute care/critical care setting
Active, current and unrestricted RN licensure in the state of residence
2+ years of clinical experience in a medical-surgical or specialty area
Managed Care experience preferred, especially Utilization Management
Associate degree required
BSN preferred
Proficiency with computer skills, including navigating multiple systems and keyboarding
Effective verbal and written communication skills
Ability to multitask, prioritize and adapt effectively to a fast-paced, changing environment
Ability to perform close inspection of handwritten and computer-generated documents and PC monitors
Ability to work weekends, holidays and evening hours as part of a 24/7 operation

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being