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Full Time Cvs Health Utilization Management Jobs

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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 Aug 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.

More about Full Time Cvs Health Utilization Management jobs
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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 August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, and 5% 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.

Utilization Management Clinical

BUTTE HOME HEALTH INC

Chico, CA • On-site

$50 - $60/hr

Full-time

Posted 20 days ago

Job description

The Utilization Manager, Registered Nurse, is an office-based nursing position responsible for supporting high-quality patient care through clinical oversight, utilization management, and real-time guidance to field clinicians. This role serves as a key clinical resource within the organization, assisting with nursing calls, care coordination, and clinical decision-making to promote positive patient outcomes while ensuring regulatory and payer compliance.

Key responsibilities include:

  • Provide clinical support and guidance to field clinicians, including RNs, LVNs, and therapy staff.

  • Take and triage nursing calls from clinicians, patients, and caregivers as appropriate.

  • Collaborate with field staff to assist with clinical problem-solving, patient status changes, and care planning.

  • Review plans of care and clinical documentation to ensure appropriate utilization of services and skilled need.

  • Monitor visit frequencies and service utilization in alignment with physician orders, payer guidelines, and agency standards.

  • Support case managers with recertifications, discharges, transitions of care, and care coordination.

  • Participate in interdisciplinary collaboration to promote continuity of care and effective communication.

  • Identify clinical risks or concerns and escalate issues appropriately.

  • Support compliance with Medicare Conditions of Participation, regulatory requirements, and agency policies.

  • Contribute to quality improvement initiatives focused on patient outcomes, documentation accuracy, and clinical best practices.

Required Qualifications

  • Active Registered Nurse (RN) license in the state of California.

  • Strong clinical assessment, critical-thinking, and decision-making skills.

  • Excellent verbal and written communication skills.

  • Ability to work collaboratively with interdisciplinary teams.

  • Proficiency with electronic medical records (EMR) systems and basic computer applications.

Preferred Qualifications

  • Experience in utilization management, case management, or clinical coordination.

  • Home Health experience preferred but not required.

  • Knowledge of Medicare home health regulations, payer guidelines, and Conditions of Participation.

  • Experience providing clinical support, education, or mentorship to field clinicians.

  • Strong organizational skills with the ability to manage multiple priorities in a fast-paced office environment.

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