New York, NY · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... This fulltime position is eligible for a comprehensive benefits package designed to support the ...
New York, NY · Remote
$29.10 - $62.32/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... This fulltime position is eligible for a comprehensive benefits package designed to support the ...
$80K - $95K/yr
Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual ...
$80K - $95K/yr
Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual ...
Nemours is seeking a Full-Time Utilization Management RN to join our team in Wilmington, DE! The Utilization Management Nurse is responsible for the monitoring patient plan of care for timely ...
Nemours is seeking a Full-Time Utilization Management RN to join our team in Wilmington, DE! The Utilization Management Nurse is responsible for the monitoring patient plan of care for timely ...
Nemours is seeking a Full-Time Utilization Management RN to join our team in Wilmington, DE! The Utilization Management Nurse is responsible for the monitoring patient plan of care for timely ...
Nemours is seeking a Full-Time Utilization Management RN to join our team in Wilmington, DE! The Utilization Management Nurse is responsible for the monitoring patient plan of care for timely ...
The ISNP Utilization Management Nurse is supervised by a Utilization Management Supervisor and is responsible for evaluating a member's clinical condition through the review of medical records ...
The ISNP Utilization Management Nurse is supervised by a Utilization Management Supervisor and is responsible for evaluating a member's clinical condition through the review of medical records ...
Columbus, IN · On-site
Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization Management ...
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Columbus, IN · On-site
Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization Management ...
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
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 ...
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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 ...
Chapel Hill, NC · On-site +1
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 ...
Chapel Hill, NC · On-site +1
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 ...
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
New
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
New
Oak Brook, IL · On-site +1
We have an innovative organization looking to add a Lead Utilization Management Nurse to its team. Their main purpose is to enable physicians to engage, support, and manage new value-based savings ...
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Oak Brook, IL · On-site +1
We have an innovative organization looking to add a Lead Utilization Management Nurse to its team. Their main purpose is to enable physicians to engage, support, and manage new value-based savings ...
$34 - $55/hr
Monitors and identifies patterns or trends in utilization management; monitors potential and actual ... full-time employees • Wellness Programs • Employee Assistance Programs and more *Benefit ...
$34 - $55/hr
Monitors and identifies patterns or trends in utilization management; monitors potential and actual ... full-time employees • Wellness Programs • Employee Assistance Programs and more *Benefit ...
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
New
Quick apply
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
New
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
New
Quick apply
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
New
Oak Brook, IL · On-site
$35.50 - $53.25/hr
Department: 11215 Advocate Aurora Health Corporate - Utilization Management Status: Full time ... Registered Nurse license issued by the state in which the team member practices. Education Required:
Oak Brook, IL · On-site
$35.50 - $53.25/hr
Department: 11215 Advocate Aurora Health Corporate - Utilization Management Status: Full time ... Registered Nurse license issued by the state in which the team member practices. Education Required:
Los Angeles, CA · On-site
$60 - $75/hr
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
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Los Angeles, CA · On-site
$60 - $75/hr
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
New
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
New
Be Seen First
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization ...
Quick apply
Be Seen First
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization ...
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Quick apply
Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Annapolis, MD · On-site
$34 - $55/hr
Monitors and identifies patterns or trends in utilization management; monitors potential and actual ... full-time employees • Wellness Programs • Employee Assistance Programs and more *Benefit ...
Annapolis, MD · On-site
$34 - $55/hr
Monitors and identifies patterns or trends in utilization management; monitors potential and actual ... full-time employees • Wellness Programs • Employee Assistance Programs and more *Benefit ...
$39K - $50.3K
15% of jobs
$50.3K - $61.5K
8% of jobs
$63.2K is the 25th percentile. Wages below this are outliers.
$61.5K - $72.8K
15% of jobs
The median wage is $79.9K / yr.
$72.8K - $84.1K
20% of jobs
$84.1K - $95.4K
11% of jobs
$101K is the 75th percentile. Wages above this are outliers.
$95.4K - $106.6K
13% of jobs
$106.6K - $117.9K
5% of jobs
$117.9K - $129.2K
3% of jobs
$129.2K - $140.5K
4% of jobs
$140.5K - $151.7K
3% of jobs
$151.7K - $163K
3% of jobs
$39K
$89.5K
$163K
| Aspect | Full Time Cvs Utilization Management Nurse | Full Time Cvs Case Manager |
|---|---|---|
| Credentials | RN license, utilization review certification | RN license, case management certification |
| Work Environment | Utilization review teams, insurance companies | Patient homes, healthcare facilities, insurance companies |
| Employer & Industry | Healthcare insurers, managed care organizations | Hospitals, healthcare providers, insurers |
Both roles require RN licensure and related certifications, but the Utilization Management Nurse focuses on reviewing medical necessity and optimizing resource use, while the Case Manager coordinates patient care and discharge planning. The roles often overlap but serve distinct functions within healthcare and insurance settings.
$29.10 - $62.32/hr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 3 days ago
5.8
Based on 4,316 frontline employees who took The Breakroom Quiz
87th of 109 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 ourselvesaccountable 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.
UM Nurse Consultant
Fully Remote- WFH
Schedule : Tuesday-Saturday 9:30am-6:00pm
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
-Must have 3+ years of Med Surg experience as an RN in the hospital setting
- 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
- Knowledge of Medicare/Medicaid
- Managed care experience
- Utilization Management experience
Education
Associates Degree in Nursing required
BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$29.10 - $62.32This 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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Health care and social assistance and retail
10,000+ Employees
Woonsocket, RI, US
