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Commission Cvs Health Utilization Management Jobs in Minnesota

CVS Health

SM 10252

Hastings, MN · On-site

$56K - $90K/yr

As a CVS Health Store Manager (SM), you will be a single-unit retail leader responsible for leading ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

CVS Health

Pharmacy Manager

Minneapolis, MN

$65 - $85/hr

... management, oversight and operation of all aspects within your pharmacy. This includes: Patient ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

CVS Health

SM

Hastings, MN · On-site

$56K - $90K/yr

As a CVS Health Store Manager (SM), you will be a single-unit retail leader responsible for leading ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

CVS Health

Pharmacy Manager

Andover, MN · On-site

$65 - $85/hr

Inventory Management * Financial Profitability * Loss Prevention * Workflow Management A key ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

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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 Minnesota?

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

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

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

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

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

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

Cities in Minnesota 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 Minnesota as of August 2026, with employment types broken down into 2% As Needed, 75% Full Time, 16% Part Time, 6% Contract, and 1% Nights. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

Behavioral Health Utilization Management Clinician

Minneapolis, MN • Remote

Adecco
Recruiting and Staffing Services • 10K+ employees
Learn more about Adeccoexternal

$39 - $41.40/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago

Job description

Adecco Healthcare & Life Sciences is currently hiring a Behavioral Health Utilization Management Clinician for a remote telecommute opportunity in Nevada.

This is a remote opportunity with a Monday–Friday schedule.

Please review the details below and apply with an updated resume for consideration.

Position Details:

·       Pay: $39 to $41.40/hour

·       Contract: Four to Six-Contract, possibility of extension or becoming permanent

·       Location: Remote / Telecommute

·       Schedule: Monday–Friday, 8:00 AM–5:00 PM PST

Primary Responsibilities:

·       Review outpatient ABA requests for medical necessity using established clinical criteria, including MCG, InterQual, ASAM, and plan-specific guidelines.

·       Evaluate treatment plans, progress reports, assessments, and supporting documentation submitted by providers.

·       Collaborate with providers to clarify documentation and ensure the appropriate level of care.

·       Make determinations or recommendations for approval, modification, or denial of services.

·       Document clinical decisions and rationale accurately in the utilization management system.

·       Review clinical information and apply established guidelines to support appropriate behavioral health services.

·       Manage multiple cases in a high-volume, deadline-driven environment.

·       Collaborate with internal clinical and administrative teams to support quality patient care.

Qualifications:

·       BCBA, LBA, RN, Master's degree in Social Work, or related behavioral health field.

·       LCSW, LPC, LMFT, or equivalent behavioral health credentials accepted.

·       Active, unrestricted behavioral health license in the State of Nevada preferred.

·       Minimum of 2 years of behavioral health clinical experience, including ABA experience.

·       Familiarity with Medicaid and commercial benefit structures and utilization management protocols.

·       Experience reviewing clinical documentation and determining medical necessity.

·       Ability to work independently and effectively within a remote team environment.

·       Proficiency with clinical systems, Microsoft Office applications, and electronic documentation platforms.

·       Strong ability to multitask and meet deadlines in a high-volume environment.

·       Experience in behavioral health utilization management or prior authorization.

Why Work for Adecco?

·       Excellent Weekly Pay

·       401(k) Plan

·       Skills Training

·       Medical, Dental, and Vision Benefits


Pay Details: $39.00 to $41.40 per hour
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer/Veterans/Disabled
Military connected talent encouraged to apply
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adecco.com/en-us/candidate-privacy
The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
  • The California Fair Chance Act
  • Los Angeles City Fair Chance Ordinance
  • Los Angeles County Fair Chance Ordinance for Employers
  • San Francisco Fair Chance Ordinance

Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.