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 ...
Quick apply
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
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
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 ...
Dir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based)
Morrisville, NC · Remote
Provide education to hospitals, nursing homes and other care providers concerning departmental ... Advise the Utilization Management Committee regarding service line trends and operational key ...
Dir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based)
Morrisville, NC · Remote
Provide education to hospitals, nursing homes and other care providers concerning departmental ... Advise the Utilization Management Committee regarding service line trends and operational key ...
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 ...
Remote Registered Nurse (RN) Case Manager
Raleigh, NC · Remote
$50K/yr
Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus. * Case management or Clinical Trial Nurse experience, a plus. * Bachelor's degree preferred. * Remote work ...
Remote Registered Nurse (RN) Case Manager
Raleigh, NC · Remote
$50K/yr
Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus. * Case management or Clinical Trial Nurse experience, a plus. * Bachelor's degree preferred. * Remote work ...
Remote Registered Nurse (RN) Case Manager
Raleigh, NC · On-site +1
$50K/yr
Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus. * Case management or Clinical Trial Nurse experience, a plus. * Bachelor's degree preferred. * Remote work ...
Remote Registered Nurse (RN) Case Manager
Raleigh, NC · On-site +1
$50K/yr
Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus. * Case management or Clinical Trial Nurse experience, a plus. * Bachelor's degree preferred. * Remote work ...
Inside Sales Representative - Remote - 2932707
Raleigh, NC · Remote
$30/hr
The Inside Sales Representative (ISR) will manage an assigned territory and engage healthcare ... utilization of Thyrogen (thyrotropin alfa for injection) . The ISR will build and maintain ...
Inside Sales Representative - Remote - 2932707
Raleigh, NC · Remote
$30/hr
The Inside Sales Representative (ISR) will manage an assigned territory and engage healthcare ... utilization of Thyrogen (thyrotropin alfa for injection) . The ISR will build and maintain ...
The Inside Sales Representative (ISR) will manage an assigned territory and engage healthcare ... utilization of Thyrogen ® (thyrotropin alfa for injection) . The ISR will build and maintain ...
The Inside Sales Representative (ISR) will manage an assigned territory and engage healthcare ... utilization of Thyrogen ® (thyrotropin alfa for injection) . The ISR will build and maintain ...
Case Manager Nurse Advocate- Raleigh area
Raleigh, NC · On-site +1
SYNERGY HEALTHCARE: Case Manager Nurse Advocate- Greater Raleigh Area Job Summary: We are seeking ... This opportunity allows for remote work so can be flexible on location. Minimal travel within the ...
Case Manager Nurse Advocate- Raleigh area
Raleigh, NC · On-site +1
SYNERGY HEALTHCARE: Case Manager Nurse Advocate- Greater Raleigh Area Job Summary: We are seeking ... This opportunity allows for remote work so can be flexible on location. Minimal travel within the ...
... ) to serve our patient population in the navigation, prevention and management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team ...
... ) to serve our patient population in the navigation, prevention and management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team ...
... ) to serve our patient population in the navigation, prevention and management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team ...
Quick apply
... ) to serve our patient population in the navigation, prevention and management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team ...
Develop, document, and drive the customer buying process through full utilization of a territory ... Remote or field-based positions will have different workplace arrangements which will be indicated ...
Develop, document, and drive the customer buying process through full utilization of a territory ... Remote or field-based positions will have different workplace arrangements which will be indicated ...
US-NC-REMOTE Position Role Type: Remote U.S. Citizen, U.S. Person, or Immigration Status ... The utilization of OTAs to achieve that objective has increased and expanded by all RTX Business ...
US-NC-REMOTE Position Role Type: Remote U.S. Citizen, U.S. Person, or Immigration Status ... The utilization of OTAs to achieve that objective has increased and expanded by all RTX Business ...
Lead RN - NC - Primarily Remote
Raleigh, NC · Remote
$100K - $115K/yr
Location & Work Requirements The operational model for this role is primarily remote, with required ... Oversees the day-to-day activities of the care management team (RNs and CHPs), monitoring ...
Lead RN - NC - Primarily Remote
Raleigh, NC · Remote
$100K - $115K/yr
Location & Work Requirements The operational model for this role is primarily remote, with required ... Oversees the day-to-day activities of the care management team (RNs and CHPs), monitoring ...
The Inside Sales Representative (ISR) will manage an assigned territory and engage healthcare ... Remote Work Environment * Career Growth and Professional Development Opportunities Required ...
The Inside Sales Representative (ISR) will manage an assigned territory and engage healthcare ... Remote Work Environment * Career Growth and Professional Development Opportunities Required ...
Lead Software Asset Management Specialist
Raleigh, NC · On-site +1
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Ability to travel 0-10%, on average, based on the work you do; this role is predominantly remote ...
Lead Software Asset Management Specialist
Raleigh, NC · On-site +1
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Ability to travel 0-10%, on average, based on the work you do; this role is predominantly remote ...
Remote Psychiatric Nurse Practitioner (PMHNP) - North Carolina
Raleigh, NC · Remote
$180K - $215K/yr
Comprehensive psychiatric evaluations, treatment planning and medication management ... Comfort practicing in a fully remote, telepsychiatry-based model * Proficiency using electronic ...
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Remote Psychiatric Nurse Practitioner (PMHNP) - North Carolina
Raleigh, NC · Remote
$180K - $215K/yr
Comprehensive psychiatric evaluations, treatment planning and medication management ... Comfort practicing in a fully remote, telepsychiatry-based model * Proficiency using electronic ...
Sales Operations Manager
Raleigh, NC · Remote
$116K - $145K/yr
This is a remote role based in East coast. Sales Operations Managers at Collibra are responsible ... Early improvements in forecast consistency and utilization tracking should be evident. * Within ...
Sales Operations Manager
Raleigh, NC · Remote
$116K - $145K/yr
This is a remote role based in East coast. Sales Operations Managers at Collibra are responsible ... Early improvements in forecast consistency and utilization tracking should be evident. * Within ...
Workflow Manager, Pharmacovigilance Operations (Specialist II, PSS) US Remote
Durham, NC · Remote
$80K - $105K/yr
... utilization of resources to support high-quality service delivery. The Workflow Manager provides ... Work with Data Management or client on reconciliation of safety databases, if appropriate.
Workflow Manager, Pharmacovigilance Operations (Specialist II, PSS) US Remote
Durham, NC · Remote
$80K - $105K/yr
... utilization of resources to support high-quality service delivery. The Workflow Manager provides ... Work with Data Management or client on reconciliation of safety databases, if appropriate.
Remote Psychiatric Mental Health Nurse Practitioner
Quick apply
Remote Psychiatric Mental Health Nurse Practitioner
Remote Cvs Utilization Management Nurse information
See Raleigh, NC salary details
$20.80 - $25
2% of jobs
$25 - $29.21
9% of jobs
$32.09 is the 25th percentile. Wages below this are outliers.
$29.21 - $33.42
21% of jobs
The median wage is $36.82 / hr.
$33.42 - $37.62
23% of jobs
$37.62 - $41.83
13% of jobs
$45.10 is the 75th percentile. Wages above this are outliers.
$41.83 - $46.03
10% of jobs
$46.03 - $50.24
8% of jobs
$50.24 - $54.45
5% of jobs
$54.45 - $58.65
5% of jobs
$58.65 - $62.86
2% of jobs
$62.86 - $67.06
2% of jobs
$20
$41
$67
How much do remote cvs utilization management nurse jobs pay per hour?
As of Jul 30, 2026, the average hourly pay for remote cvs utilization management nurse in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.
What is the difference between Remote Cvs Utilization Management Nurse vs Remote Cvs Case Manager?
| Aspect | Remote Cvs Utilization Management Nurse | Remote Cvs Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, case management certification |
| Work Environment | Utilization review teams, insurance companies | Patient advocacy, care coordination teams |
| Employer & Industry | Health insurance, managed care organizations | Health insurance, healthcare providers |
Both roles require RN licensure and related certifications, but the Utilization Management Nurse focuses on reviewing medical necessity and approving services, while the Case Manager emphasizes coordinating patient care and discharge planning. Understanding these differences helps job seekers find the right fit within the healthcare and insurance industries.
What are the most commonly searched types of Cvs Utilization Management Nurse jobs in Raleigh, NC? The most popular types of Cvs Utilization Management Nurse jobs in Raleigh, NC are:
What are popular job titles related to Remote Cvs Utilization Management Nurse jobs in Raleigh, NC? For Remote Cvs Utilization Management Nurse jobs in Raleigh, NC, the most frequently searched job titles are:
- Utilization Review Nurse
- Remote Chart Review Nurse
- Remote Utilization Management
- Remote Prior Authorization Nurse
- Utilization Review Rn
- Night Utilization Review Nurse
- Evening Utilization Review Nurse
- Overnight Utilization Review Nurse
- Evening Optum Health Utilization Review
- Independent Contractor Remote Utilization Management Nurse
What job categories do people searching Remote Cvs Utilization Management Nurse jobs in Raleigh, NC look for? The top searched job categories for Remote Cvs Utilization Management Nurse jobs in Raleigh, NC are:
- Nurse Practitioner Utilization Review
- Utilization Review
- Remote Occupational Therapy Utilization Review
- Registered Nurse Reviewer
- Remote Preservice Review Nurse
- Remote Bcba Utilization Review
- Chart Utilization Review
- Registered Nurse Case Review
- Remote Utilization Review Nurse Practitioner
- Optum Utilization Review Nurse
What cities near Raleigh, NC are hiring for Remote Cvs Utilization Management Nurse jobs? Cities near Raleigh, NC with the most Remote Cvs Utilization Management Nurse job openings:
Full-time
Posted 22 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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