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Cvs Utilization Review Jobs in Texas (NOW HIRING)

CVS Health

Grad Pharmacist

Killeen, TX · On-site

$15 - $18.50/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Marshall, TX

$13.75 - $17/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Grapevine, TX · On-site

$15.50 - $19.25/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Brownsville, TX

$14.50 - $17.75/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Conroe, TX

$14.25 - $17.75/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Forest Hill, TX

$16.25 - $20.25/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Victoria, TX

$15.75 - $19.50/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Fort Worth, TX

$16 - $20/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Killeen, TX

$15 - $18.50/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Paris, TX

$12.75 - $15.75/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Victoria, TX · On-site

$12.50 - $15.50/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Sulphur Springs, TX · On-site

$13.75 - $17/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Pharmacy Intern - Grad

San Antonio, TX

$15 - $18.75/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Lindale, TX

$13.50 - $16.75/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Burleson, TX · On-site

$14.75 - $18.25/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

CVS Health

Grad Pharmacist

Houston, TX

$16 - $19.75/hr

At CVS Health, we are focused on transforming health care for our customers and making our company ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

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Cvs Utilization Review information

What is CVS Utilization Review?

CVS Utilization Review refers to the process used by CVS Health to evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. This process typically involves reviewing medical records, claims, and treatment plans to ensure that patients receive appropriate care while avoiding unnecessary services or costs. Utilization reviewers work to balance quality patient care with cost-effectiveness, often collaborating with healthcare providers to achieve the best outcomes. This role is important in managing healthcare resources and supporting insurance and pharmacy benefit management functions.

What are some common challenges faced by CVS Utilization Review professionals, and how can they be addressed?

CVS Utilization Review professionals often encounter challenges such as balancing the need for cost-effective care with ensuring patient safety and satisfaction. They may also navigate complex medical records, communicate with diverse healthcare providers, and manage tight deadlines for review approvals. Staying current with ever-changing healthcare regulations and insurance policies is crucial. Strong organizational skills, effective communication, and ongoing professional development can help address these challenges, ensuring both compliance and high-quality patient care.

What are the key skills and qualifications needed to thrive as a CVS Utilization Review nurse?

To thrive as a CVS Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and a valid RN license, often with experience in case management or utilization review. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines and regulatory standards are typical technical requirements. Strong communication, attention to detail, and the ability to navigate complex case discussions are vital soft skills for this role. These competencies ensure accurate, efficient evaluations of medical necessity, compliance with regulations, and effective collaboration with healthcare providers and insurers.

What is the difference between Cvs Utilization Review vs Medical Billing Specialist?

AspectCvs Utilization ReviewMedical Billing Specialist
CredentialsCertifications in case management or utilization review, relevant healthcare experienceMedical billing certifications, coding certifications (CPC, CCS)
Work EnvironmentHealthcare facilities, insurance companies, utilization review departmentsMedical offices, billing companies, healthcare providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsMedical practices, billing services, healthcare providers
Search & Comparison IntentUnderstanding utilization review roles, certification differencesBilling processes, coding, reimbursement procedures

While both roles operate within healthcare, Cvs Utilization Review focuses on evaluating medical necessity and approving services, whereas Medical Billing Specialists handle coding, billing, and reimbursement processes. Understanding these differences helps clarify career paths and job expectations in healthcare administration.

What are popular job titles related to Cvs Utilization Review jobs in Texas? For Cvs Utilization Review jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Cvs Utilization Review jobs in Texas look for? The top searched job categories for Cvs Utilization Review jobs in Texas are:
Cvs Utilization Review jobs near you
Infographic showing various Cvs Utilization Review job openings in Texas as of August 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Hybrid job distribution.

Utilization Management Nurse Consultant

CVS Health

Mountain Home, TX • On-site

$26.01 - $62.32/hr

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 6 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,329 frontline employees who took The Breakroom Quiz

88th of 111 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 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-6:00pm 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:

$26.01 - $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: 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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