The Utilization Management Nurse performs medical necessity and benefit review requests in ... Collaborates with healthcare partners to ensure timely review of services and care. * Provides ...
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The Utilization Management Nurse performs medical necessity and benefit review requests in ... Collaborates with healthcare partners to ensure timely review of services and care. * Provides ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in ... healthcare partners to ensure timely review of services and care. • Provides referrals to Case ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in ... healthcare partners to ensure timely review of services and care. • Provides referrals to Case ...
This role enables associates to work virtually full-time, except for required in-person training ... Who We Are Elevance Health is a health company dedicated to improving lives and communities - and ...
This role enables associates to work virtually full-time, except for required in-person training ... Who We Are Elevance Health is a health company dedicated to improving lives and communities - and ...
Utilization Manager
Durham, NC · On-site
... with health care team members related to care coordination and utilization management ... Employment Type: FULL_TIME
Utilization Manager
Durham, NC · On-site
... with health care team members related to care coordination and utilization management ... Employment Type: FULL_TIME
... full-time underwriter and Aetna's underwriting organization. This program serves as one of the ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)
... full-time underwriter and Aetna's underwriting organization. This program serves as one of the ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)
Utilization Manager
Durham, NC · On-site
Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team ...
Utilization Manager
Durham, NC · On-site
Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team ...
... full-time underwriter and Aetna's underwriting organization. This program serves as one of the ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)
... full-time underwriter and Aetna's underwriting organization. This program serves as one of the ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)
Utilization Manager
Durham, NC · On-site
Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team ...
Utilization Manager
Durham, NC · On-site
Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team ...
UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)
Morrisville, NC · On-site +1
$69K - $88K/yr
The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently ... This position is full-time remote. Selected candidate must reside in North Carolina and be willing ...
UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)
Morrisville, NC · On-site +1
$69K - $88K/yr
The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently ... This position is full-time remote. Selected candidate must reside in North Carolina and be willing ...
UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)
Morrisville, NC · On-site +1
$69K - $88K/yr
The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently ... This position is full-time remote. Selected candidate must reside in North Carolina and be willing ...
UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)
Morrisville, NC · On-site +1
$69K - $88K/yr
The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently ... This position is full-time remote. Selected candidate must reside in North Carolina and be willing ...
... with health care team members related to care coordination and utilization management ... Employment Type: FULL_TIME
... with health care team members related to care coordination and utilization management ... Employment Type: FULL_TIME
Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team ...
Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team ...
Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team ...
Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team ...
Responsibilities & Duties Utilization Reviews and Management * Conduct independent medical ... Identify high risk consumers and those with special health care needs for referral to Care ...
Responsibilities & Duties Utilization Reviews and Management * Conduct independent medical ... Identify high risk consumers and those with special health care needs for referral to Care ...
Responsibilities & Duties Utilization Reviews and Management * Conduct independent medical ... Identify high risk consumers and those with special health care needs for referral to Care ...
Responsibilities & Duties Utilization Reviews and Management * Conduct independent medical ... Identify high risk consumers and those with special health care needs for referral to Care ...
Dispensing Pharmacist - Long Term Care - Full Time
$50.48 - $84.62/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... management's goals and objectives within the dispensing pharmacy. This pharmacist will provide ...
Dispensing Pharmacist - Long Term Care - Full Time
$50.48 - $84.62/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... management's goals and objectives within the dispensing pharmacy. This pharmacist will provide ...
Operations Manager
Cary, NC · On-site
$19 - $29/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Sales and inventory management * Employee staffing, training, and development * Financial ...
Operations Manager
Cary, NC · On-site
$19 - $29/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Sales and inventory management * Employee staffing, training, and development * Financial ...
Operations Manager
$19 - $29/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Sales and inventory management * Employee staffing, training, and development * Financial ...
Operations Manager
$19 - $29/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Sales and inventory management * Employee staffing, training, and development * Financial ...
Operations Manager
$19 - $29/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Sales and inventory management * Employee staffing, training, and development * Financial ...
Operations Manager
$19 - $29/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Sales and inventory management * Employee staffing, training, and development * Financial ...
Store Manager in Training
$18.50 - $23.88/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Support your store as management team member and lead in a manner that is consistent with CVS ...
Store Manager in Training
$18.50 - $23.88/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Support your store as management team member and lead in a manner that is consistent with CVS ...
Full Time Cvs Health Utilization Management information
See Raleigh, NC salary details
$37.9K - $48.9K
15% of jobs
$48.9K - $59.8K
8% of jobs
$61.4K is the 25th percentile. Wages below this are outliers.
$59.8K - $70.8K
15% of jobs
The median wage is $77.7K / yr.
$70.8K - $81.7K
20% of jobs
$81.7K - $92.7K
11% of jobs
$98.2K is the 75th percentile. Wages above this are outliers.
$92.7K - $103.7K
13% of jobs
$103.7K - $114.6K
5% of jobs
$114.6K - $125.6K
3% of jobs
$125.6K - $136.5K
4% of jobs
$136.5K - $147.5K
3% of jobs
$147.5K - $158.4K
3% of jobs
$37.9K
$87K
$158.4K
How much do full time cvs health utilization management jobs pay per year?
As of Aug 6, 2026, the average yearly pay for full time cvs health utilization management in Raleigh, NC is $86,984.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,700.00 and $101,600.00 per year, depending on experience, location, and employer.
What is the difference between Full Time Cvs Health Utilization Management vs Utilization Review Nurse?
| Aspect | Full Time Cvs Health Utilization Management | Utilization Review Nurse |
|---|---|---|
| Certifications | RN license, possibly certifications like CCM or CUC | RN license, certifications like CCM or CUC |
| Work Environment | Corporate healthcare setting, office-based | Hospital, clinic, or insurance company |
| Employer & Industry | CVS Health, healthcare/insurance industry | Hospitals, insurance companies, healthcare providers |
| Job Focus | Managing utilization for CVS members, coordinating care | Reviewing 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.
What are the most commonly searched types of Cvs Health Utilization Management jobs in Raleigh, NC? The most popular types of Cvs Health Utilization Management jobs in Raleigh, NC are:
What are popular job titles related to Full Time Cvs Health Utilization Management jobs in Raleigh, NC? For Full Time Cvs Health Utilization Management jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Full Time Cvs Health Utilization Management jobs in Raleigh, NC look for? The top searched job categories for Full Time Cvs Health Utilization Management jobs in Raleigh, NC are:
- Behavioral Health Care Manager
- Behavioral Health Coordinator
- Behavioral Health Registered Nurse
- Insurance Utilization Reviewer
- Internship Remote Utilization Review
- Weekend Clinical Appeals Analyst
- Utilization Care Manager
- Remote Mercy Behavioral Health
- Utilization Review Coordinator
- Associates Degree In Psychology
What cities near Raleigh, NC are hiring for Full Time Cvs Health Utilization Management jobs? Cities near Raleigh, NC with the most Full Time Cvs Health Utilization Management job openings:
Full-time
Posted 29 days ago
Job description
About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
• Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
• Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
• Collaborates with healthcare partners to ensure timely review of services and care.
• Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
• Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
• Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
• Triages and prioritizes cases and other assigned duties to meet required turnaround times.
• Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
• Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
• Duties as assigned.
Essential Qualifications
• Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Must be able to work independently.
• Must be detail oriented and have strong organizational and time management skills.
• Adaptive to a high pace and changing environment- flexibility in assignment.
• Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
• Proficient in MCG and CMS criteria sets
• Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
• Working knowledge of URAC and NCQA.
• 2+ years’ experience in a UM team within managed care setting.
• 3+ years’ experience in clinical nurse setting preferred.
• TPA Experience preferred.
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
• Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
• Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
• Collaborates with healthcare partners to ensure timely review of services and care.
• Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
• Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
• Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
• Triages and prioritizes cases and other assigned duties to meet required turnaround times.
• Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
• Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
• Duties as assigned.
Essential Qualifications
• Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Must be able to work independently.
• Must be detail oriented and have strong organizational and time management skills.
• Adaptive to a high pace and changing environment- flexibility in assignment.
• Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
• Proficient in MCG and CMS criteria sets
• Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
• Working knowledge of URAC and NCQA.
• 2+ years’ experience in a UM team within managed care setting.
• 3+ years’ experience in clinical nurse setting preferred.
• TPA Experience preferred.
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About Brighton Health Plan Solutions
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