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Cvs Utilization Management Nurse Jobs (NOW HIRING)

CVS Health

MI · On-site

$26.01 - $68.55/hr

At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... utilization/benefit management function. Required Qualifications 3+ years of experience as an RN ...

CVS Health

Utilization Management Nurse Consultant

Home, PA · On-site

$29.10 - $62.32/hr

At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... N licensure in state of residence * Utilization Management is a 24/7 operation and work schedules ...

CVS Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

Registered Nurse (RN) - Utilization Management Join a dynamic healthcare team where your clinical ... 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

At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... N licensure in state of residence - Utilization Management is a 24/7 operation and work schedules ...

CVS Health

Utilization Management Nurse Consultant

Home, KS · On-site

$26.01 - $56.14/hr

At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... N licensure in state of residence * Utilization Management is a 24/7 operation and work schedules ...

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $56.14/hr

CVS Health Utilization Management Position We're building a world of health around every individual ... Registered Nurse in adult acute care/critical care setting - Must have active current and ...

Oak St. Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

CVS Health Utilization Management Position We're building a world of health around every individual ... Must have active current and unrestricted RN licensure in state of residence. Utilization ...

Oak St. Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

CVS Health Utilization Management Position We're building a world of health around every individual ... Required Qualifications 2+ years of experience as a Registered Nurse in adult acute care/critical ...

Oak St. Health

Utilization Management Nurse Consultant

$29.10 - $62.32/hr

At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... Utilization Management experience Education: Associates Degree in Nursing required BSN preferred ...

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $68.55/hr

At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ...

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $68.55/hr

At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ...

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $68.55/hr

At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ...

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Cvs Utilization Management Nurse information

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$39K

$89.5K

$163K

How much do cvs utilization management nurse jobs pay per year?

As of Aug 10, 2026, the average yearly pay for cvs utilization management nurse in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What are the typical responsibilities of a CVS Utilization Management Nurse?

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.

What are the key skills and qualifications needed to thrive as a CVS Utilization Management Nurse?

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.

What is a CVS Utilization Management Nurse?

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.

More about Cvs Utilization Management Nurse jobs
What cities are hiring for Cvs Utilization Management Nurse jobs? Cities with the most Cvs Utilization Management Nurse job openings:
What are the most commonly searched types of Cvs Utilization Management Nurse jobs? The most popular types of Cvs Utilization Management Nurse jobs are:
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Cvs Utilization Management Nurse jobs near you
Infographic showing various Cvs Utilization Management Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

Utilization Management Nurse Consultant

CVS Health

Jackson, MS • On-site

$26.01 - $56.14/hr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 7 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,332 frontline employees who took The Breakroom Quiz

89th of 112 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 ourselves accountable 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 Nurse (RN) - 24/7 Operations

Location: Remote (Preference for CST/MT time zones)

Schedule: 8:00 am to 5:00 pm Includes evenings, weekends, and holidays

Are you a detail-oriented RN with a passion for improving patient outcomes and healthcare efficiency? Join our Utilization Management team and play a key role in ensuring members receive the right care at the right time.

What You'll Do

  • Review clinical information and apply guidelines to make coverage determinations across the care continuum

  • Collaborate with providers and internal teams to coordinate care and support treatment plans

  • Identify opportunities to enhance quality, efficiency, and member outcomes

  • Refer members to appropriate programs, services, and resources

  • Serve as a clinical expert in utilization and benefit management

What You Bring - Required

  • Active, unrestricted RN license in your state of residence

  • 2+ years of recent experience in adult acute or critical care

  • Strong clinical judgment, communication, and multitasking skills

  • Comfort working in a fast-paced, technology-driven environment

  • Associates Degree in Nursing

Preferred Qualifications

  • Experience in Med-Surg or a specialty clinical area

  • Managed care or Utilization Management experience

  • BSN preferred

  • Residence in CST or MT time zone

Work Environment

  • Remote, sedentary role with frequent computer and phone use

  • Requires attention to detail, productivity, and quality standards

Why Join Us?

Be part of a collaborative team that makes a meaningful impact on patient care and healthcare outcomes every day.

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 full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being 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 (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 08/08/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

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