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Full Time Cvs Health Utilization Management Jobs

This role ensures appropriate use of healthcare services, regulatory compliance, and optimal ... In conjunction with the Corp VP, Case Management & Utilization, develop and implement a system-wide ...

Pay Range $34--$55 USD Luminis Health Benefits Overview: • Medical, Dental, and Vision Insurance ... full-time employees • Wellness Programs • Employee Assistance Programs and more *Benefit ...

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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
What cities are hiring for Full Time Cvs Health Utilization Management jobs? Cities with the most Full Time Cvs Health Utilization Management job openings:
What are the most commonly searched types of Cvs Health Utilization Management jobs? The most popular types of Cvs Health Utilization Management jobs are:
What states have the most Full Time Cvs Health Utilization Management jobs? States with the most job openings for Full Time Cvs Health Utilization Management jobs include:
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.

Director, Utilization Management

Alameda Health System

Oakland, CA • On-site

Full-time

Medical, Retirement, PTO

Re-posted 3 days ago


Alameda Health System rating

8.3

Company rating: 8.3 out of 10

Based on 16 frontline employees who took The Breakroom Quiz


Job description

  • 100% employer health plan for employees and their eligible dependents
  • Unique benefit offerings that are partially or 100% employer-paid
  • Rich and varied retirement plans and the ability to participate in multiple plans.
  • Generous paid time off plans

Role Overview:

Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic planning, compliance, and collaboration. Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician collaboration, and aligns with organizational objectives while adapting to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: Following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification. 

  • Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. 
  • Monitor and evaluate the utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures. 
  • Analyze data and generate reports on utilization trends, outcomes and quality indicators to support decision-making and process improvement initiatives. Reports to appropriate committees. 
  • Manage quality of performance criteria, policies and procedures, and service standards for the utilization management operations. Evaluate utilization reviews and determine program improvements.  
  • Develop and implement utilization review policies and procedures in accordance with industry standards and regulatory requirements.  
  • Direct and coordinate data gathering and record keeping legally required by federal and state agencies, the Joint Commission, and hospital policies; participates in the risk mitigation, process of implementing new or revised processes, and projects 
  • Foster effective communication and collaboration with internal departments, external agencies, and insurance providers to facilitate the utilization review process. 
  • Participate in interdisciplinary committees and meetings to contribute to the development and implementation of quality improvement initiatives.  
  • Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals. Maintains minimal denial rates by Medicare, MediCal, private and contracted payers through appropriate direction of utilization practices; assists physicians and hospital personnel in understanding UM matters. 
  • Perform all other duties as assigned. 
  • Prepares cost analysis reports and other data needed for the preparation of the departmental budget. 
  • Provides in-house educational programs as needed for both staff and physicians. 
  • Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of UM and administrative staff. 
  • Serves as a content expert to staff and internal departments and external partners; networks with other hospitals, nursing organizations, and professional organizations to keep abreast of changes within the profession.

MINIMUM QUALIFICATIONS:

Required Education: Bachelor’s degree in Nursing

Preferred Education: Master’s degree in Nursing 

Required Experience: Three years of utilization review experience. Health insurance company and/or acute care hospital, post-acute and psych; three years of InterQual and/or MCG. Strong clinical nursing background.

Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.

Preferred Licenses/Certifications: UM / CM certifications


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