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Remote Cvs Utilization Management Nurse Jobs (NOW HIRING)

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** RN working ... Utilization management experience LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin ...

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How much do remote cvs utilization management nurse jobs pay per hour?

As of Jun 25, 2026, the average hourly pay for remote cvs utilization management nurse in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

How to make an extra 2000 a month as a nurse?

A remote CVS Utilization Management Nurse can increase income by taking on additional shifts, working overtime, or pursuing specialized certifications to qualify for higher-paying roles. Developing skills in case management, coding, or telehealth can also open opportunities for freelance consulting or part-time work outside regular hours.

Are CVS remote jobs legit?

CVS Health offers remote utilization management nurse positions that are legitimate employment opportunities. These roles typically involve reviewing patient data and coordinating care remotely, often requiring relevant nursing licenses and experience. Candidates should verify job postings directly on official CVS careers pages to avoid scams.

How to make 300,000 dollars as a nurse online?

A Remote CVS Utilization Management Nurse can increase earnings by gaining specialized certifications, such as case management or utilization review, and building experience in telehealth or remote case management roles. High-paying opportunities often require strong clinical knowledge, excellent communication skills, and proficiency with healthcare management software, enabling nurses to work in senior or leadership positions that offer higher compensation.

What is the difference between Remote Cvs Utilization Management Nurse vs Remote Cvs Case Manager?

AspectRemote Cvs Utilization Management NurseRemote Cvs Case Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification
Work EnvironmentUtilization review teams, insurance companiesPatient advocacy, care coordination teams
Employer & IndustryHealth insurance, managed care organizationsHealth 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 is the salary range for CVS remote jobs?

The salary for a remote CVS utilization management nurse typically ranges from $60,000 to $85,000 annually, depending on experience, location, and certifications. Compensation may also include benefits such as health insurance and paid time off, with some roles offering additional incentives for remote work flexibility.
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Remote Cvs Utilization Management Nurse jobs near you

Medical Director - Utilization Management (Part Time)

Astrana Health, Inc.

Monterey Park, CA • On-site, Remote

$250K - $325K/yr

Part-time

Posted 7 days ago

Job description

Medical Director - Utilization Management (Part Time)
Department: HS - UM
Employment Type: Part Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Dr. Dinesh Kumar
Description
About the Role
The Part‑Time Medical Director - Utilization Management, Outpatient Services provides physician oversight for medical necessity, appropriateness, and utilization decisions across Astrana Health's outpatient, ancillary, and professional services. This role supports Astrana's delegated risk arrangements by ensuring compliant, evidence‑based utilization while partnering closely with outpatient clinical leadership, UM operations, and health plan stakeholders.
What You'll Do
  • Provide physician oversight and final determination for outpatient utilization management activities, including prior authorizations, retrospective reviews, and appeals.
  • Ensure medical necessity and appropriateness of outpatient services such as specialty referrals, diagnostics, imaging, DME, therapies, and procedures.
  • Support compliance with delegated health plan requirements, regulatory standards, and accreditation guidelines.
  • Conduct peer‑to‑peer reviews and outpatient physician education to improve documentation, guideline adherence, and appropriate utilization.
  • Partner with Outpatient Medical Directors, Population Health, and UM nursing teams to align utilization decisions with Astrana's value‑based care strategy.
  • Identify outpatient utilization trends, leakage, and variation; recommend clinical strategies to improve cost efficiency and quality outcomes.
  • Serve as clinical liaison with health plans and external vendors on outpatient UM‑related matters.

Qualifications
  • MD or DO; Board Certified in Internal Medicine, Family Medicine, or a relevant outpatient specialty required.
  • Active, unrestricted medical license (California required).
  • Prior experience in outpatient utilization management, health plan medical management, or delegated risk environments.
  • Strong understanding of outpatient medical necessity criteria, prior authorization workflows, and appeals processes.
  • Experience working with PCPs and ambulatory specialists in value‑based care models.
  • Strong physician‑to‑physician communication and clinical judgment.

Environmental Job Requirements and Working Conditions
  • This is a Remote - US based position.
  • The national target base salary range for this role is: $250,000 - $325,000. Actual compensation will be determined based on geographic location (current or future), experience, or other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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