Utilization Management Nurse Consultant

CVS Health

Utilization Management Nurse Consultant assessing and coordinating healthcare services for patients at CVS Health. Requires RN licensure and offers flexible working conditions within a 24/7 service environment.

Posted 7/2/2026full-timeRemote • Tennessee • 🇺🇸 United StatesJuniorMid-Level💰 $26 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in clinical assessment, care coordination, and utilization management, with a strong focus on promoting quality healthcare services and effective benefit utilization. Holds active RN licensure and possesses extensive experience in adult acute care and critical care settings.

Highest-signal resume keywords

Registered Nurse LicensureUtilization ManagementClinical AssessmentCare CoordinationManaged Care Experience

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical JudgmentCoverage DeterminationHealthcare Services EvaluationAdult Acute Care ExperienceCritical Care ExperienceMed Surg ExperienceSpecialty Area Experience

Soft Skills

CollaborationCommunicationProblem-Solving

Industry Keywords

Healthcare ServicesBenefit UtilizationQuality EffectivenessReferral OpportunitiesUtilization/Benefit Management

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.

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
Managed Care experience preferred, especially Utilization Management
Preference for those residing in EST zones

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
bonus eligibility