Richmond, VA · On-site
$26.01 - $68.55/hr
Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ... Schedule Fully Remote- WFH M-F 8A-5P EST/9A-6P CST with 1 hour lunch Position Summary Position ...
New
Richmond, VA · On-site
$26.01 - $68.55/hr
Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ... Schedule Fully Remote- WFH M-F 8A-5P EST/9A-6P CST with 1 hour lunch Position Summary Position ...
New
Danville, VA · On-site
$79K - $95K/yr
... their homes or other community-based settings. Visit us online: www.thehughescenter.com The ... The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
Danville, VA · On-site
$79K - $95K/yr
... their homes or other community-based settings. Visit us online: www.thehughescenter.com The ... The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
Summary The Utilization Review Specialist supports the organization's utilization management ... from the Department of Labor.
Summary The Utilization Review Specialist supports the organization's utilization management ... from the Department of Labor.
Summary The Utilization Review Specialist supports the organization's utilization management ... from the Department of Labor.
Summary The Utilization Review Specialist supports the organization's utilization management ... from the Department of Labor.
Collaborates with hospital, home care, care management, and other providers effectively to ensure ... time away from work, and paid holidays. Please note: There may be opportunity for remote work ...
Collaborates with hospital, home care, care management, and other providers effectively to ensure ... time away from work, and paid holidays. Please note: There may be opportunity for remote work ...
Collaborates with hospital, home care, care management, and other providers effectively to ensure ... time away from work, and paid holidays. Please note: The opportunity for remote work may be ...
Collaborates with hospital, home care, care management, and other providers effectively to ensure ... time away from work, and paid holidays. Please note: The opportunity for remote work may be ...
Collaborates with hospital, home care, care management, and other providers effectively to ensure ... time away from work, and paid holidays. Please note: There may be opportunity for remote work ...
Collaborates with hospital, home care, care management, and other providers effectively to ensure ... time away from work, and paid holidays. Please note: There may be opportunity for remote work ...
Williamsburg, VA · On-site
Coordinates, performs, and monitors all utilization review/management activities of the hospital to ... Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work ...
Williamsburg, VA · On-site
Coordinates, performs, and monitors all utilization review/management activities of the hospital to ... Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work ...
... management of onsite and remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred Utilization Manager experience preferred Previous Managed Care experience ...
... management of onsite and remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred Utilization Manager experience preferred Previous Managed Care experience ...
... management of onsite and remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred Utilization Manager experience preferred Previous Managed Care experience ...
... management of onsite and remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred Utilization Manager experience preferred Previous Managed Care experience ...
... Utilization Management Physician Advisor to ensure patient status is accurate and compliant with ... from a state that is part of a compact agreement with Virginia * Acute care hospital experience or ...
... Utilization Management Physician Advisor to ensure patient status is accurate and compliant with ... from a state that is part of a compact agreement with Virginia * Acute care hospital experience or ...
Williamsburg, VA · On-site
$24 - $28/hr
Coordinates, performs, and monitors all utilization review/management activities of the hospital to ... Education/Requirements: • Graduation from an approved/accredited school of nursing or a Bachelor ...
Williamsburg, VA · On-site
$24 - $28/hr
Coordinates, performs, and monitors all utilization review/management activities of the hospital to ... Education/Requirements: • Graduation from an approved/accredited school of nursing or a Bachelor ...
Fishersville, VA · On-site
$35.43 - $54.21/hr
... Utilization Management Physician Advisor to ensure patient status is accurate and compliant with ... from a state that is part of a compact agreement with Virginia * Acute care hospital experience or ...
Fishersville, VA · On-site
$35.43 - $54.21/hr
... Utilization Management Physician Advisor to ensure patient status is accurate and compliant with ... from a state that is part of a compact agreement with Virginia * Acute care hospital experience or ...
... Utilization Management Physician Advisor to ensure patient status is accurate and compliant with ... from a state that is part of a compact agreement with Virginia * Acute care hospital experience or ...
... Utilization Management Physician Advisor to ensure patient status is accurate and compliant with ... from a state that is part of a compact agreement with Virginia * Acute care hospital experience or ...
Hampton, VA · On-site
$62K/yr
Clinical Coordinator - Utilization Review Annual Salary: $62,406 Work Schedule: Monday - Friday 8 ... Major duties will include conducting clinical reviews, acute care bed management, and communication ...
Hampton, VA · On-site
$62K/yr
Clinical Coordinator - Utilization Review Annual Salary: $62,406 Work Schedule: Monday - Friday 8 ... Major duties will include conducting clinical reviews, acute care bed management, and communication ...
Hampton, VA · On-site
$62K - $66K/yr
Manage and monitor acute care bed availability and placements to support timely and appropriate ... Prepare utilization reports and provide data-driven recommendations to support regional behavioral ...
Hampton, VA · On-site
$62K - $66K/yr
Manage and monitor acute care bed availability and placements to support timely and appropriate ... Prepare utilization reports and provide data-driven recommendations to support regional behavioral ...
Hampton, VA · On-site
$62K - $66K/yr
Manage and monitor acute care bed availability and placements to support timely and appropriate ... Prepare utilization reports and provide data-driven recommendations to support regional behavioral ...
Hampton, VA · On-site
$62K - $66K/yr
Manage and monitor acute care bed availability and placements to support timely and appropriate ... Prepare utilization reports and provide data-driven recommendations to support regional behavioral ...
In this position, you will ensure all utilization management and training processes are completed ... Graduation from an accredited university with at least a bachelor's degree in psychology ...
In this position, you will ensure all utilization management and training processes are completed ... Graduation from an accredited university with at least a bachelor's degree in psychology ...
In this position, you will ensure all utilization management and training processes are completed ... Graduation from an accredited university with at least a bachelor's degree in psychology ...
In this position, you will ensure all utilization management and training processes are completed ... Graduation from an accredited university with at least a bachelor's degree in psychology ...
... home health?utilization?management experience for a health plan?? * Effective telephonic and ... Thursday - Sunday Work-At-Home Requirements ? ? * Must have the ability to provide a high-speed DSL ...
... home health?utilization?management experience for a health plan?? * Effective telephonic and ... Thursday - Sunday Work-At-Home Requirements ? ? * Must have the ability to provide a high-speed DSL ...
| Aspect | From Home Utilization Management | From Home Case Management |
|---|---|---|
| Certifications | CPUR, CCM, or similar | CPUR, CCM, or similar |
| Work Environment | Remote, healthcare insurance companies | Remote, healthcare insurance companies |
| Primary Focus | Reviewing medical necessity and resource utilization | Coordinating patient care and services |
| Employer Usage | Health insurers, managed care organizations | Health insurers, managed care organizations |
From Home Utilization Management primarily focuses on evaluating medical necessity and resource utilization, ensuring appropriate healthcare services. In contrast, From Home Case Management emphasizes coordinating patient care and services to support health outcomes. Both roles are remote, require similar certifications, and are used within healthcare insurance companies, but their core responsibilities differ.
The most popular types of Utilization Management jobs in Virginia are:
Cities in Virginia with the most From Home Utilization Management job openings:
$26.01 - $68.55/hr
Other
Medical, Dental, Vision, Retirement, PTO
This job post has expired today. Applications are no longer accepted.
5.8
Based on 4,335 frontline employees who took The Breakroom Quiz
89th of 112 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 is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
Schedule
Fully Remote- WFH
M-F 8A-5P EST/9A-6P CST with 1 hour lunch
Position Summary
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
3+ years of experience as an RN
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
Prior authorization utilization experience preferred
Outpatient Clinical experience
Knowledge of Medicare/Medicaid
Managed care experience
Education
Associates Degree in Nursing required
BSN preferred
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$26.01 - $68.55
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: 08/12/2026
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
