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Cvs Health Utilization Management Jobs in Georgia

Clarvida - Georgia

Utilization Manager

Savannah, GA · On-site

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... Health, Dependent and Transportation Flexible Spending Accounts * Employee, Spouse and Dependent ...

Clarvida - Georgia

Utilization Manager

Savannah, GA

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... Health, Dependent and Transportation Flexible Spending Accounts * Employee, Spouse and Dependent ...

Clarvida - Georgia

Utilization Manager

Savannah, GA · On-site

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... Health, Dependent and Transportation Flexible Spending Accounts * Employee, Spouse and Dependent ...

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Cvs Health Utilization Management information

What is CVS Health Utilization Management?

CVS Health Utilization Management refers to a set of services and processes used to ensure that patients receive appropriate, effective, and efficient health care. This involves reviewing medical necessity, appropriateness, and efficiency of health care services, procedures, and facilities under the provisions of a health benefits plan. At CVS Health, Utilization Management professionals work with healthcare providers, payers, and patients to optimize care outcomes while controlling costs. They help determine coverage decisions, coordinate care, and assist in managing complex cases.

What is the difference between Cvs Health Utilization Management vs Cvs Health Case Management?

AspectCvs Health Utilization ManagementCvs Health Case Management
Primary FocusReviewing and authorizing healthcare services to ensure appropriate utilizationCoordinating patient care and connecting patients with resources
Work EnvironmentUtilization review teams, insurance settingsPatient homes, healthcare facilities, community settings
CredentialsRN, LPN, or other healthcare certificationsRN, social worker, or case management certifications
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers

While both roles involve healthcare professionals, Utilization Management focuses on reviewing services for appropriateness, whereas Case Management emphasizes coordinating comprehensive patient care. Understanding these differences helps in choosing the right career path or job search focus within the healthcare industry.

What are some typical challenges faced by CVS Health Utilization Management professionals, and how can they be addressed?

Utilization Management professionals at CVS Health often encounter challenges such as balancing clinical decision-making with cost-effectiveness, managing high caseloads, and navigating complex insurance policies. Staying updated on healthcare regulations, maintaining clear communication with providers, and leveraging the company's decision-support tools can help address these challenges. Regular collaboration with interdisciplinary teams also ensures that patient care remains the top priority while meeting organizational guidelines.

What are the key skills and qualifications needed to thrive in CVS Health Utilization Management?

To thrive as a CVS Health Utilization Management Nurse, you need a current RN license, strong clinical judgment, and experience in case management or utilization review. Familiarity with utilization review software, electronic health records (EHRs), and knowledge of insurance guidelines and regulatory requirements is typically expected. Excellent communication, attention to detail, and critical thinking skills help in advocating for patients and collaborating with healthcare providers. These skills ensure effective care coordination, compliance with policies, and optimized patient outcomes in a managed care environment.

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

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

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

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

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

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

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

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

Cvs Health Utilization Management jobs near you
Infographic showing various Cvs Health Utilization Management job openings in Georgia as of August 2026, with employment types broken down into 48% As Needed, and 52% Part Time. Highlights an 100% In-person job distribution.

Utilization Manager

Clarvida - Georgia

Savannah, GA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 27 days ago

Job description

Utilization Manager

LCSW, LPC, LMSW, LAPC

As our Utilization Manager, you will coordinate Utilization Management functions for the agency. 

  • Trains staff on proper documentation, including assessments, treatment planning, progress notes, transition/discharge plans
  • Provides feedback to staff regarding changes needed in order to meet service guidelines, fidelity review, and licensure requirements
  • Trains staff on proper submission of Registration, Authorization and Discharge requests
  • Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of pended authorizations
  • Tracks utilization of services and compliance with contractual requirements
  • Assists in the coordination of external audits
  • Develops and implements any corrective action plans needed
  • Completes regular testing of the electronic medical record functionality

Perks of this role:

  • 8:30am-5:00pm weekday office schedule
  • Stability and growth opportunities working with a national agency

Do the Following Apply to You?

  • Licensed as LCSW, LPC, LMSW, or LAPC
  • Ability to communicate effectively, both orally and in writing.
  • Ability to train others

What we offer:

  • Full Time Employees:
    • Paid vacation days that increase with tenure
    • Separate sick leave that rolls over each year
    • Up to 10 Paid holidays*
    • Medical, Dental, Vision benefit plan options
    • Employee Assistance Program
    • Health, Dependent and Transportation Flexible Spending Accounts
    • Employee, Spouse and Dependent Basic and Optional Life Insurance
  • All Employees:
    • 401 K Plan
    • Mileage & Cell Phone Reimbursement (or company phone)
    • Pet Insurance
    • DailyPay- daily access to your earnings without waiting for payday!
    • SoFi at Work student loan refinancing
    • Next Steps Financial Wellness program webinars and tools
    • Company laptop and great IT support
    • Verizon discount
    • Dell discount
    • Perks at Pathways national discounts on travel, shopping, and entertainment
    • Training, Development and Continuing Education Credits for licensure requirements
    • Opportunities for advancement!  As we grow, you grow with us!

To Learn More About Us:

Pathways @ http://www.pathways.com/mission-vision-and-values/ 

Current openings @ https://www.pathways.com/working-at-pathways
Pathways is an equal opportunity employer with a commitment to diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, disability, veteran status or any other protected characteristic.
*- benefit availability may vary by State/County 

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