New York, NY · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Utilization Management experience Education Associates Degree in Nursing required BSN preferred ...
New York, NY · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Utilization Management experience Education Associates Degree in Nursing required BSN preferred ...
$80K - $95K/yr
Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual ...
$80K - $95K/yr
Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual ...
Akron, OH · On-site +1
The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources and serving as a resource to the hospital staff on utilization ...
Akron, OH · On-site +1
The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources and serving as a resource to the hospital staff on utilization ...
The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources and serving as a resource to the hospital staff on utilization ...
The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources and serving as a resource to the hospital staff on utilization ...
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
The ISNP Utilization Management Nurse is supervised by a Utilization Management Supervisor and is responsible for evaluating a member's clinical condition through the review of medical records ...
The ISNP Utilization Management Nurse is supervised by a Utilization Management Supervisor and is responsible for evaluating a member's clinical condition through the review of medical records ...
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Oak Brook, IL · On-site +1
We have an innovative organization looking to add a Lead Utilization Management Nurse to its team. Their main purpose is to enable physicians to engage, support, and manage new value-based savings ...
Quick apply
Oak Brook, IL · On-site +1
We have an innovative organization looking to add a Lead Utilization Management Nurse to its team. Their main purpose is to enable physicians to engage, support, and manage new value-based savings ...
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Quick apply
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Los Angeles, CA · On-site
$60 - $75/hr
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
Quick apply
Los Angeles, CA · On-site
$60 - $75/hr
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Be Seen First
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization ...
Quick apply
Be Seen First
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization ...
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Quick apply
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Dubuque, IA · On-site
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys ...
Dubuque, IA · On-site
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys ...
Dubuque, IA · On-site
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys ...
Dubuque, IA · On-site
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys ...
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys ...
Quick apply
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys ...
Utilization Management Nurse Consultant Duration : 6 months (Possible ext) Location : Downers Grove, IL Responsibilities : Facilitate the delivery of appropriate benefits and/or healthcare ...
Utilization Management Nurse Consultant Duration : 6 months (Possible ext) Location : Downers Grove, IL Responsibilities : Facilitate the delivery of appropriate benefits and/or healthcare ...
Dalton, GA · On-site
JOB PURPOSE The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms. ESSENTIAL JOB DUTIES ...
Dalton, GA · On-site
JOB PURPOSE The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms. ESSENTIAL JOB DUTIES ...
$39K - $50.3K
15% of jobs
$50.3K - $61.5K
8% of jobs
$63.2K is the 25th percentile. Wages below this are outliers.
$61.5K - $72.8K
15% of jobs
The median wage is $79.9K / yr.
$72.8K - $84.1K
20% of jobs
$84.1K - $95.4K
11% of jobs
$101K is the 75th percentile. Wages above this are outliers.
$95.4K - $106.6K
13% of jobs
$106.6K - $117.9K
5% of jobs
$117.9K - $129.2K
3% of jobs
$129.2K - $140.5K
4% of jobs
$140.5K - $151.7K
3% of jobs
$151.7K - $163K
3% of jobs
$39K
$89.5K
$163K
A CVS Utilization Management Nurse typically reviews hospital admissions, outpatient procedures, and ongoing treatments to ensure medical necessity and compliance with coverage guidelines. Daily tasks often include collaborating with healthcare providers, assessing clinical documentation, and communicating decisions to both patients and providers. Nurses in this role may also participate in team meetings, contribute to quality improvement initiatives, and stay current with policy updates. This position offers the opportunity to work closely with a multidisciplinary team while utilizing both clinical expertise and critical thinking skills.
To thrive as a Cvs Utilization Management Nurse, you need a solid clinical background in nursing, current RN licensure, and experience in medical necessity reviews and case management. Proficiency with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like CMS and NCQA are vital. Strong analytical skills, attention to detail, effective communication, and the ability to multitask make candidates stand out in this role. These skills ensure accurate evaluations, efficient care coordination, and compliance with industry standards, which are critical for improving patient outcomes and optimizing healthcare resources.
A CVS Utilization Management Nurse is responsible for reviewing patient care to ensure treatments are medically necessary and cost-effective. They assess healthcare services against clinical guidelines, work with providers to coordinate patient care, and help manage insurance approvals. Their role involves applying evidence-based criteria to make coverage decisions, preventing unnecessary procedures, and supporting quality care. This position is critical in balancing patient needs with healthcare costs while ensuring compliance with industry regulations.
$29.10 - $62.32/hr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 27 days ago
5.8
Based on 4,285 frontline employees who took The Breakroom Quiz
81st of 104 rated pharmacies
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.
Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
UM Nurse Consultant
Fully Remote- WFH
Schedule : Tuesday-Saturday 9:30am-6:00pm
Position Summary:
UM Nurse Consultant
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/recommendation along 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.
Required Qualifications
-Must have 3+ years of Med Surg experience as an RN in the hospital setting
- Active and unrestricted RN licensure in state of residence
- Able to work in multiple IT platforms/systems
- 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)
Preferred Qualifications
- Knowledge of Medicare/Medicaid
- Managed care experience
- Utilization Management experience
Education
Associates Degree in Nursing required
BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$29.10 - $62.32This 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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
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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Health care and social assistance and retail
10,000+ Employees
Woonsocket, RI, US
