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Commission Cvs Health Utilization Management Jobs

CVS Health

Utilization Management Nurse Consultant

$26.01 - $56.14/hr

Position Summary Utilization Management is a 24/7 operation and work schedules will include ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

CVS Health

Utilization Management Nurse Consultant

$26.01 - $56.14/hr

Position Summary Utilization Management is a 24/7 operation and work schedules will include ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

CVS Health

Utilization Management Nurse Consultant

$29.10 - $62.32/hr

... utilization/benefit management function. Required Qualifications 3+ years of experience as an RN ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

ISHE

$36 - $94/hr

Position Summary As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

University of Minnesota School of Nursing

$74.53/hr

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

CVS Health

Prior Authorization UM Nurse Consultant

Influence healthcare quality and member outcomes * Grow your career in Utilization Management and ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

CVS Health

Prior Authorization UM Nurse Consultant

... health care one person, one family and one community at a time. Utilization Management Nurse ... This position is eligible for a CVS Health bonus, commission or short-term incentive program in ...

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

As of Sep 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?

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.

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Commission Cvs Health Utilization Management jobs near you
Infographic showing various Commission Cvs Health Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, and 5% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

NICU Utilization Management Nurse Consultant - Louisiana Residence Preferred

CVS Health

Remote

$26.01 - $56.14/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,366 frontline employees who took The Breakroom Quiz

92nd of 113 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.

NICU Utilization Management Nurse Consultant (Remote)

Are you passionate about improving outcomes for the most vulnerable patients? We are seeking an experienced NICU Utilization Management Nurse Consultant to support high-risk neonatal populations through clinical review, care coordination, and evidence-based decision-making.

In this role, you will collaborate with neonatologists, hospitals, case managers, and interdisciplinary teams to evaluate medical necessity, determine appropriate levels of care, and facilitate timely, cost-effective services for newborns and infants requiring specialized care. You'll play a critical role in supporting quality outcomes, discharge planning, and seamless transitions of care while ensuring compliance with regulatory and accreditation standards.

What You'll Bring - REQUIRED

  • Active, unrestricted RN license in the state of residence. Ability to obtain and maintain additional state licensure as required by business needs.
  • 3+ years of clinical NICU nursing experience minimum
  • 1+ years of experience in utilization management, case management, managed care, NICU, pediatrics, or maternal-child health
  • Strong knowledge of neonatal intensive care, prematurity, congenital conditions, and complex infant care needs
  • Experience reviewing medical records and applying evidence-based clinical criteria (MCG or similar tools)
  • Excellent clinical judgment, communication, and collaboration skills
  • Proficiency with electronic medical records and utilization management systems
  • Associates Degree in Nursing

Preferred Qualifications

  • BSN
  • NICU, pediatric inpatient, maternal-child health, or neonatal case management experience
  • Health plan utilization management experience (Medicaid, Medicare, or Commercial)
  • Experience supporting Louisiana Medicaid populations
  • Louisiana residency preferred

Why Join Us?

  • Meaningful work that directly impacts neonatal and infant health outcomes
  • Collaborative, mission-driven environment
  • Opportunity to leverage your NICU expertise in a remote setting
  • Focus on quality, innovation, and member-centered care

If you're a skilled RN with a passion for neonatal care and utilization management, we'd love to hear from you. Apply today to help ensure the right care is delivered at the right time for our smallest patients.

Work from Home Requirements:

  • You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
  • A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
  • Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
  • The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
  • If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

  • Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
  • Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
  • Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
  • Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
  • Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
  • Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

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: 09/12/2026

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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