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How much do commission cvs health utilization management jobs pay per hour?

As of Jul 6, 2026, the average hourly pay for commission cvs health utilization management in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a Commission CVS Health Utilization Management role?

A Commission CVS Health Utilization Management role involves evaluating and coordinating healthcare services to ensure patients receive appropriate, cost-effective care. These professionals assess medical necessity, review authorization requests, and work closely with providers, patients, and insurance plans. Their goal is to optimize healthcare resources while maintaining quality care standards, often by applying clinical guidelines and industry regulations. The role typically requires a background in healthcare, nursing, or pharmacy and strong analytical and communication skills.

What are the key skills and qualifications needed to thrive as a CVS Health Utilization Management professional, and why are they important?

To thrive as a CVS Health Utilization Management professional, you need a background in healthcare, strong analytical skills, and typically a valid RN license or relevant clinical degree. Familiarity with utilization review systems, electronic health records (EHR), and regulatory guidelines such as Medicare and Medicaid is essential. Strong communication, attention to detail, and critical thinking are standout soft skills for this role. These skills are vital to ensure appropriate, cost-effective patient care and compliance with healthcare policies.

What are the typical challenges faced by a Commission CVS Health Utilization Management professional when reviewing complex cases?

Commission CVS Health Utilization Management professionals often encounter challenges such as interpreting nuanced medical information, staying updated with evolving clinical guidelines, and balancing cost-effectiveness with patient care needs. Complex cases may require collaboration with physicians, nurses, and pharmacists, as well as thorough documentation to ensure compliance with regulations. Managing a high volume of cases while maintaining accuracy and timeliness is also a common aspect of the role.

What is the difference between Commission Cvs Health Utilization Management vs Utilization Review Nurse?

AspectCommission Cvs Health Utilization ManagementUtilization Review Nurse
CertificationsCPUR, CCM, or relevant healthcare certificationsRN license, possibly with certifications like CURN
Work EnvironmentInsurance companies, healthcare providers, or managed care organizationsHospitals, clinics, or insurance companies
Primary ResponsibilitiesReviewing medical necessity, authorizing services, managing utilization dataAssessing patient records, determining care appropriateness, authorizing treatments

Both roles focus on evaluating healthcare services, but Commission Cvs Health Utilization Management often involves broader program oversight and data analysis, while Utilization Review Nurses primarily conduct clinical assessments. Understanding these differences helps job seekers identify the right career path in healthcare utilization roles.

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Commission Cvs Health Utilization Management jobs near you
Utilization Management Nurse Consultant

Utilization Management Nurse Consultant

CVS Health

New York, NY

$26.01 - $68.55/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 13 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,273 frontline employees who took The Breakroom Quiz

78th of 101 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

  • 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/recommendationalong 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


Required Qualifications

- 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


Preferred Qualifications

- 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


Education

Associates Degree required

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $68.55

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 07/08/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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