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Entry Level Utilization Management Nurse Jobs (NOW HIRING)

Oak St. Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

... N licensure in state of residence Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications - 2+ years of clinical ...

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $74.78/hr

... N licensure in state of residence Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications - 2+ years of clinical ...

CVS Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

... N licensure in state of residence Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications 2+ years of clinical ...

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$39K

$89.5K

$163K

How much do entry level utilization management nurse jobs pay per year?

As of Jul 11, 2026, the average yearly pay for entry level 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 some common challenges faced by Entry Level Utilization Management Nurses during their first year on the job?

Entry Level Utilization Management Nurses often encounter challenges such as adapting to the fast-paced decision-making required in assessing medical necessity, interpreting insurance policies, and learning to communicate effectively with both providers and insurance representatives. Navigating complex healthcare regulations and documentation requirements can also be overwhelming at first. However, most organizations provide thorough onboarding, mentorship, and ongoing training to help new nurses build confidence and proficiency in these areas.

What are the key skills and qualifications needed to thrive as an Entry Level Utilization Management Nurse, and why are they important?

To thrive as an Entry Level Utilization Management Nurse, you need an active RN license, a solid understanding of clinical guidelines, and a basic knowledge of healthcare regulations such as Medicare and Medicaid. Familiarity with utilization review software, electronic health records (EHRs), and clinical documentation systems is typically required. Strong analytical thinking, attention to detail, effective communication, and the ability to collaborate with healthcare teams are essential soft skills in this role. These skills and qualifications ensure accurate patient care reviews, compliance with regulations, and the delivery of cost-effective, quality healthcare.

What is an Entry Level Utilization Management Nurse?

An Entry Level Utilization Management Nurse is a registered nurse who works within healthcare organizations or insurance companies to review medical cases and ensure that patients receive appropriate, cost-effective care. They assess treatment plans, evaluate the necessity of medical procedures, and help coordinate services to avoid unnecessary hospitalizations. These nurses use clinical guidelines and their medical knowledge to make recommendations, often working closely with physicians, healthcare providers, and insurance representatives. The position is typically suited for nurses who are early in their careers and interested in the intersection of clinical practice and healthcare administration.

What is the difference between Entry Level Utilization Management Nurse vs Utilization Review Nurse?

AspectEntry Level Utilization Management NurseUtilization Review Nurse
CertificationsRN license, possibly some utilization management trainingRN license, often additional certifications like CCM or URAC
Work EnvironmentHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare facilities, third-party review organizations
Job FocusAssessing patient needs for appropriate care, initial reviewReviewing medical necessity, approving or denying services

While both roles involve reviewing healthcare services, the Entry Level Utilization Management Nurse typically focuses on initial assessments and coordinating patient care, whereas the Utilization Review Nurse often concentrates on detailed reviews for approval or denial of services, often requiring additional certifications.

More about Entry Level Utilization Management Nurse jobs
What cities are hiring for Entry Level Utilization Management Nurse jobs? Cities with the most Entry Level Utilization Management Nurse job openings:
What are the most commonly searched types of Utilization Management Nurse jobs? The most popular types of Utilization Management Nurse jobs are:
What states have the most Entry Level Utilization Management Nurse jobs? States with the most job openings for Entry Level Utilization Management Nurse jobs include:
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Entry Level Utilization Management Nurse jobs near you
Utilization Management Nurse Consultant

Utilization Management Nurse Consultant

CVS Health

Richmond, VA • On-site

$29.10 - $62.32/hr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 12 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,277 frontline employees who took The Breakroom Quiz

81st of 104 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.

Position Summary

This Utilization Management Nurse Consultant (UMNC) position is 100% remote.

As a Utilization Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program and our plan sponsor(s). You would be responsible for ensuring the member is receiving the appropriate care, at the appropriate time, and at the appropriate location using designated criteria, while adhering to federal and state regulated turn-around times. This includes reviewing written and electronic clinical records. We are looking for someone who is highly motivated, detail-oriented, highly organized, and works well in a team environment.

Through the use of clinical tools and information/data review, the UM Nurse Consultant reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning, and works closely with facilities and providers to meet complex needs of the member.

Required Qualifications

-Must have active current and unrestricted RN license in state of residence

-Minimum of 3 years of acute hospital clinical experience as an RN

-Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods of time

-A private designated workspace free of distractions and high-speed internet

-Must be willing and able to work Monday-Friday 8am-5pm EST with occasional weekend on-call and holiday rotation.

Preferred Qualifications

-Candidate must possess strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues.

-Experience with all types of Microsoft Office including PowerPoint, Excel, and Word

-Strong telephonic communication skills

-1+ years of Utilization Review experience

-1+ years of Managed Care experience

Education

Associate's Degree Required

BSN preferred

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: 07/31/2026

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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