Richmond, VA · On-site
$29.10 - $62.32/hr
At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote ...
Richmond, VA · On-site
$29.10 - $62.32/hr
At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote ...
$29.10 - $62.32/hr
Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) We're building a ... At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ...
$29.10 - $62.32/hr
Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) We're building a ... At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ...
$29.10 - $62.32/hr
Utilization Management Nurse Consultant We're building a world of health around every individual ... At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ...
New
$29.10 - $62.32/hr
Utilization Management Nurse Consultant We're building a world of health around every individual ... At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ...
New
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
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 ...
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 ...
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 ...
$29.10 - $62.32/hr
Utilization Management Nurse Consultant We're building a world of health around every individual ... At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ...
$29.10 - $62.32/hr
Utilization Management Nurse Consultant We're building a world of health around every individual ... At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ...
$26.01 - $56.14/hr
CVS Health Job Opportunity We're building a world of health around every individual -- shaping a ... of the utilization/benefit management function. * Typical office working environment with ...
New
$26.01 - $56.14/hr
CVS Health Job Opportunity We're building a world of health around every individual -- shaping a ... of the utilization/benefit management function. * Typical office working environment with ...
New
Gainesville, FL · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate ...
Gainesville, FL · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate ...
Ocala, FL · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate ...
Ocala, FL · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate ...
$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 ...
Lakeland, FL · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate ...
Lakeland, FL · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate ...
Columbus, IN · On-site
Utilization Management Nurse Job Title: Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is ...
Columbus, IN · On-site
Utilization Management Nurse Job Title: Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is ...
Pensacola, FL · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate ...
Pensacola, FL · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate ...
Harrisburg, PA · On-site
$29.10 - $62.32/hr
At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... the utilization/benefit management program for Medicare Integrated/dually eligible member ...
Harrisburg, PA · On-site
$29.10 - $62.32/hr
At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... the utilization/benefit management program for Medicare Integrated/dually eligible member ...
Manhattan, NY · On-site
$29.10 - $62.32/hr
At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... the utilization/benefit management program for Medicare Integrated/dually eligible member ...
Manhattan, NY · On-site
$29.10 - $62.32/hr
At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... the utilization/benefit management program for Medicare Integrated/dually eligible member ...
Utilization Management Nurse Manager The Utilization Management Nurse Manager functions as a generalist at the point of care for their assigned service. He/she provides consultation to other units on ...
New
Utilization Management Nurse Manager The Utilization Management Nurse Manager functions as a generalist at the point of care for their assigned service. He/she provides consultation to other units on ...
New
Dalton, GA · On-site
Job Title Utilization Management Nurse Job Purpose The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various ...
Dalton, GA · On-site
Job Title Utilization Management Nurse Job Purpose The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various ...
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 ...
$26.01 - $56.14/hr
CVS Health Job Opportunity We're building a world of health around every individual -- shaping a ... of the utilization/benefit management function. Typical office working environment with ...
New
$26.01 - $56.14/hr
CVS Health Job Opportunity We're building a world of health around every individual -- shaping a ... of the utilization/benefit management function. Typical office working environment with ...
New
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 ...
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 ...
$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
Other
Medical, Dental, Vision, Retirement, PTO
Posted 4 days ago
5.8
Based on 4,270 frontline employees who took The Breakroom Quiz
77th of 99 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 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 Consultant Clinical Precertification RN (Medicare)
Remote | Full-Time | Weekday Schedule
Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time.
What You'll Do
Review clinical cases and make coverage determinations using evidence-based guidelines
Collaborate with providers and care teams to coordinate appropriate treatment
Apply clinical judgment to support utilization and benefit management decisions
Identify opportunities to improve care quality and member outcomes
Serve as a clinical resource across internal and external stakeholders
What You Bring - REQUIRED
Active, unrestricted RN license in the state of residence.
3+ years of RN experience, including 1+ year in Med/Surg
Strong clinical assessment and decision-making skills
Experience with Microsoft Office (Outlook, Teams, Excel)
Ability to work Monday-Friday, 9:00 AM-5:30 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
Associate Degree in Nursing
Nice to Have
Utilization Management or Prior Authorization experience
Managed care background
Familiarity with MedCompass
Ambulatory surgery experience
BSN preferred
Why Join Us?
Transition your clinical skills into a collaborative, non-bedside role
Make a meaningful impact on patient care and outcomes
Work in a supportive, team-driven environment
If you're passionate about combining clinical expertise with care coordination and healthcare quality, we'd love to hear from you!
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$29.10 - $62.32
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: 07/04/2026
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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Health care and social assistance and retail
10,000+ Employees
Woonsocket, RI, US
