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Full Time Cvs Health Utilization Management information

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$39K

$89.5K

$163K

How much do full time cvs health utilization management jobs pay per year?

As of Jul 6, 2026, the average yearly pay for full time cvs health utilization management 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 is the difference between Full Time Cvs Health Utilization Management vs Utilization Review Nurse?

AspectFull Time Cvs Health Utilization ManagementUtilization Review Nurse
CertificationsRN license, possibly certifications like CCM or CUCRN license, certifications like CCM or CUC
Work EnvironmentCorporate healthcare setting, office-basedHospital, clinic, or insurance company
Employer & IndustryCVS Health, healthcare/insurance industryHospitals, insurance companies, healthcare providers
Job FocusManaging utilization for CVS members, coordinating careReviewing medical necessity, authorizing services

Both roles require RN licensure and similar certifications, working primarily in healthcare or insurance environments. Full Time CVS Health Utilization Management focuses on managing member care within CVS, while Utilization Review Nurses typically work in hospitals or insurance companies reviewing medical necessity. The roles overlap in certification and work setting but differ in employer and specific job focus.

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Full Time Cvs Health Utilization Management jobs near you
Infographic showing various Full Time Cvs Health Utilization Management job openings in the United States as of June 2026, with employment types broken down into 80% Part Time, and 20% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

Behavioral Health Utilization Management Specialist

Barry County Community Mental Health Aut

Hastings, MI • On-site

$58K/yr

Full-time

Posted 28 days ago

Job description

Location: Primarily Remote (Michigan-based)
Schedule: Full-Time | Option for Four-Day Work Week

Position Overview:
We are seeking a detail-oriented and clinically skilled Behavioral Health Utilization Management (UM) Specialist to join our team. This role is responsible for reviewing behavioral health services to ensure medical necessity, regulatory compliance, and appropriate level of care determinations. The ideal candidate brings strong clinical judgment, experience with managed care or utilization management processes, familiarity with Community Mental Health/CMHSP operations, and the ability to work independently in a remote environment.

Key Responsibilities:

  • Conduct utilization reviews for behavioral health services, including initial, concurrent, and retrospective reviews
  • Assess clinical documentation to determine medical necessity and appropriate level of care
  • Ensure compliance with state, federal, and payer-specific regulations and guidelines
  • Collaborate with providers, care teams, and internal stakeholders to support quality service delivery
  • Maintain accurate and timely documentation of all UM activities
  • Participate in audits, quality improvement initiatives, and process enhancements
  • Stay current on best practices, regulatory updates, and industry standards in behavioral health and managed care

Qualifications:

  • Master’s degree in Social Work, Professional Counseling, Psychology, or a related behavioral health field
  • Current, active licensure in the State of Michigan (e.g., LMSW/LLMSW, LPC/LLPC, LLP/TLLP)
  • Prior experience in utilization management, managed care, or similar review functions required
  • Strong attention to detail and critical thinking skills
  • Excellent written and verbal communication abilities
  • Ability to work independently while managing multiple priorities

Preferred Qualifications:

  • Experience with behavioral health payer guidelines and authorization processes
  • Familiarity with electronic health records and UM software systems

What We Offer:

  • Four-day work week promoting work-life balance
  • Primarily remote work environment with flexible scheduling
  • Collaborative and mission-driven team culture
  • Opportunities for professional growth and development

How to Apply:
Interested candidates should submit a resume and cover letter outlining their relevant experience and licensure status.

We are an equal opportunity employer committed to diversity, equity, and inclusion in the workplace.