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Commission Cvs Health Utilization Management Jobs in Arizona

Sky Mavis

Manager Utilization Management

Tucson, AZ · On-site

$100 - $140/hr

P3 Health Partners is seeking a Utilization Management Manager to oversee the daily operations of our Utilization Management (UM) department and help drive quality, efficiency, and compliance across ...

CVS Health

Legal Counsel

Scottsdale, AZ · On-site

$144K - $288K/yr

... CVS Health's PBM, Caremark, on commercial clinical programs, including formulary management ... utilization management, and related clinical operations. * Advise clients on the application of ...

University of Kentucky

Utilization Management Reviewer Requisition Number: R-000002878 Department Name: Supervisor ... health services, compliance with payer requirements, and accuracy of admission status ...

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Commission Cvs Health Utilization Management information

What is a Commission CVS Health Utilization Management?

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 Commission CVS Health Utilization Management professional?

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.

What are the most commonly searched types of Cvs Health Utilization Management jobs in Arizona?

The most popular types of Cvs Health Utilization Management jobs in Arizona are:

What are popular job titles related to Commission Cvs Health Utilization Management jobs in Arizona?

For Commission Cvs Health Utilization Management jobs in Arizona, the most frequently searched job titles are:

What job categories do people searching Commission Cvs Health Utilization Management jobs in Arizona look for?

The top searched job categories for Commission Cvs Health Utilization Management jobs in Arizona are:

What cities in Arizona are hiring for Commission Cvs Health Utilization Management jobs?

Cities in Arizona with the most Commission Cvs Health Utilization Management job openings:

Commission Cvs Health Utilization Management jobs near you
Infographic showing various Commission Cvs Health Utilization Management job openings in Arizona as of July 2026, with employment types broken down into 1% As Needed, 86% Full Time, 9% Part Time, and 4% Contract. Highlights an 67% Physical, 1% Hybrid, and 32% Remote job distribution.

Manager Utilization Management

Tucson, AZ • On-site

P3 Health Partners
Health Care and Social Assistance • 51 - 200 employees

6.6

Company rating: 6.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Learn more about P3 Health Partnersexternal

$100K - $140K/yr

Full-time

Posted 18 days ago

Job description

Lead the Team That Drives Quality, Compliance, and Exceptional Patient Care
Are you an experienced nursing leader with a passion for utilization management, operational excellence, and team development? P3 Health Partners is seeking a Utilization Management Manager to oversee the daily operations of our Utilization Management (UM) department and help drive quality, efficiency, and compliance across the organization.
In this leadership role, you'll guide a team of UM professionals, collaborate with key clinical and operational stakeholders, and play a vital role in ensuring members receive the right care at the right time. You'll have the opportunity to influence processes, mentor staff, support organizational growth, and contribute to initiatives that improve both patient outcomes and healthcare value.
What You'll Do
As the Utilization Management Manager, you'll provide leadership, oversight, and expertise to ensure the UM department operates effectively while meeting regulatory and organizational standards.
Key Responsibilities
  • Lead and manage the daily operations of the Utilization Management department, including staff supervision, coaching, and performance management.
  • Monitor departmental workflows to ensure efficiency, accuracy, and compliance with applicable regulations and organizational requirements.
  • Serve as a subject matter expert and resource for UM staff, providing ongoing education, mentorship, and support.
  • Promote a culture of quality, accountability, and continuous improvement across the department.
  • Participate in Utilization Management and Quality Assurance committees and support organizational quality initiatives.
  • Assist with preparation for and participation in audits conducted by health plans, NCQA, CMS, and other regulatory entities.
  • Collaborate with cross-functional teams including Case Management, Clinical Operations, Quality Improvement, Claims, Network Development, Configuration, and Finance.
  • Develop, implement, and maintain departmental policies, procedures, and workflow standards.
  • Identify process improvement opportunities and provide recommendations for system enhancements and operational efficiencies.
  • Maintain expertise in Medicare Advantage regulations, managed care requirements, and provider/facility contract provisions.
  • Partner with Medical Directors to support medical necessity determinations and coordination of care activities.
  • Participate in strategic planning, budgeting activities, and organizational growth initiatives.
  • Support implementation efforts related to new markets, programs, and business expansion.

What Makes You Successful
You are a collaborative healthcare leader who balances strong clinical knowledge with operational expertise and a commitment to excellence.
Core Competencies
  • Comprehensive knowledge of Medicare Advantage regulations, utilization management practices, and healthcare compliance requirements.
  • Strong leadership and team development skills.
  • Excellent verbal and written communication abilities, including presenting complex information to diverse audiences.
  • Strong organizational and project management capabilities.
  • Ability to prioritize competing demands in a fast-paced environment.
  • Sound judgment, critical thinking, and decision-making skills.
  • Ability to foster strong relationships across departments and levels of the organization.
  • Experience utilizing referral management systems, MCG criteria, CMS guidelines, and payer portals.
  • Continuous improvement mindset focused on quality, efficiency, and member outcomes.

Qualifications
Required
  • Graduate of an accredited school of nursing.
  • Active, unrestricted Registered Nurse (RN) license in the state of Arizona, California, Nebraska, Nevada, or Oregon.
  • Ability to obtain licensure in all delegated markets within one year of hire.
  • Minimum of five (5) years of clinical nursing experience.
  • Minimum of two (2) years of experience within managed care, an HMO, or a global risk-bearing provider organization.
  • Minimum of two (2) years of supervisory or management experience.
  • Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.

Preferred
  • Bachelor's degree in Nursing (BSN).
  • Experience leading utilization management teams within a Medicare Advantage environment.
  • Experience supporting regulatory audits and accreditation activities.

Work Hours & Travel
  • Monday - Friday; occasional oversight of Saturday/Sunday progress; 8 AM - 5 PM CT
  • This role offers a hybrid work arrangement. Candidates will follow our hybrid schedule, working in office three days per week.
  • Occassional travel to delegated markets (currently AZ, CA, NE, NV, OR).

Salary Range: $100,000 - $140,000 annually.
The posted salary range reflects P3 Health Partners' good-faith estimate for this role at the time of posting. Placement within the range will be based on qualifications, experience, education, geographic location, and internal equity considerations. In addition to base salary, eligible employees may have access to a comprehensive benefits package and other compensation opportunities.
Why Join P3?
People. Passion. Purpose.
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives, and engage patients. We are a physician-led organization relentless in our mission to overcome obstacles and positively disrupt the business of healthcare, transforming it from sickness care into wellness guidance.
As a Utilization Management Manager, you'll play a critical role in helping ensure our members receive high-quality, coordinated, and cost-effective care. You'll work alongside dedicated healthcare professionals and leaders who are committed to innovation, collaboration, and improving the healthcare experience for both patients and providers.
At P3, you'll have the opportunity to make a meaningful impact while growing your career in a fast-paced and evolving organization. If you are passionate about your work, eager to have fun, and motivated to be part of a mission-driven team, we encourage you to join us.
Help shape the future of healthcare while leading a team committed to clinical excellence and positive patient outcomes.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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