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 ourselves accountable 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.
Position Summary
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
- 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.
- Typical office working environment with productivity and quality expectations.
- Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
- Sedentary work involving periods of sitting, talking, listening.
- Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
- Effective communication skills, both verbal and written
Required Qualifications
- 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
- Must have active current and unrestricted RN licensure in state of residence
- Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
Preferred Qualifications
- 2+ years of clinical experience required in med surg or specialty area
- Managed Care experience preferred, especially Utilization Management
- Preference for those residing in MST/PST zones
Education
Associates Degree required
BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$ $68.55This 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit
We anticipate the application window for this opening will close on: 02/06/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
-
Utilization Management Nurse Consultant
hace 11 horas
Gualaceo CVS Health Full time$26 - $69We are building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our co ...
-
Complex Discharge Planner
hace 4 semanas
Gualaceo Centene Corporation Full time$27 - $49You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified national organization offering competitive benefits including a fresh perspective on workplace flexibility. · ...
-
Clinical Review Nurse
hace 2 semanas
Gualaceo Centene Corporation Full time$27 - $49You could be the one who changes everything for our members as a clinical professional on our Medical Management/Health Services team. · ...
-
Clinical Review Nurse
hace 1 semana
Gualaceo Centene Corporation Full time$27 - $49You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. · ...
-
Utilization Review Clinician
hace 4 semanas
Gualaceo Centene Corporation Full time$27 - $48Can change everything for our members as a clinical professional on Medical Management/Health Services team. · Evaluates member's treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate. · P ...
-
Appeals Nurse
hace 4 semanas
Gualaceo Centene Corporation Full time$27 - $48You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. · ...
-
Lead Clinical Review Nurse
hace 2 meses
Gualaceo Centene Corporation Full time$35 - $64You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. · ...
-
Clinical Review Nurse
hace 2 meses
Gualaceo Centene Corporation Full time$27 - $48You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. · Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility ...
-
Clinical Review Nurse
hace 1 mes
Gualaceo Centene Corporation Full time$27 - $48You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ...
-
Clinical Review Nurse
hace 2 meses
Gualaceo Centene Corporation Full time$27 - $48You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. · ...
-
Clinical Review Nurse
hace 2 meses
Gualaceo Centene Corporation Full time$27 - $48You could be the one who changes everything for our members as a clinical professional on our Medical Management/Health Services team. · ...
-
Care Manager
hace 3 semanas
Gualaceo Centene Corporation Full time$56.200 - $101.000You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flex ...
-
Sales Consultant
hace 3 días
Gualaceo The Standard Full time$100.000 - $125.000 per yearWe have built an enduring legacy of stability, financial strength and exceptional customer service through the contributions of the service-oriented people who choose to work at The Standard. To ensure we can attract and retain the best talent, when you join The Standard you can ...
-
Utilization Review Clinician
hace 2 meses
Gualaceo Centene Corporation Full time$27 - $48You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ...
-
Business Development Manager
hace 3 días
Gualaceo Cencora Full time$72.200 - $103.290Join a dynamic team as a Business Development Manager, where you will play a pivotal role in driving strategic growth within the Retail Community and Specialty pharmacy market for a prestigious Fortune 10 organization. · ...
-
Manager- Specialty Engineering
hace 3 semanas
Gualaceo CVS Health Full time$60.300 - $132.600³Designing Automation Systems:¼ Develop innovative solutions for automating dispensing processes including material handling sorting picking and packing utilizing technologies such as robotics conveyor systems and goods to person systems and various automated or semi-automated pi ...
-
Data Center Technician II
hace 1 mes
Gualaceo Astreya Full time$19 - $30The Data Center Technician II will assist with installation of hardware into racks asset tagging and scanning cabling data center maintenance documenting processes server installations. · ...
-
Care Navigator Pregnancy Postpartum LPN
hace 1 semana
Debant Centene Corporation Full time$23 - $39You could be the one who changes everything for our members. Develops, assesses and coordinates care management activities based on member needs to provide quality cost effective healthcare outcomes. · ...
-
Senior Commercial Card Consultant
hace 1 día
Gualaceo U.S. Bank Full time$111.605 - $131.300At U.S. Bank we re on a journey to do our best Helping the customers and businesses we serve to make better and smarter financial decisions and enabling the communities we support to grow and succeed We believe it takes all of us to bring our shared ambition t life each person is ...
-
Care Manager
hace 2 semanas
Gualaceo Centene Corporation Full time$56.200 - $101.000You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. · Must Reside in Nevada. · Remote Care Manager – Behavioral Health | Nevada Medicaid | Centene ...
-
Care Manager
hace 2 meses
Gualaceo Centene Corporation Full time$55.100 - $99.000Centene is seeking a Remote Care Manager RN to support Medicaid members in Nevada's rural counties. This role focuses on OB case management, member enrollment, and care coordination to improve health outcomes. · Conduct OB-focused case management and enroll eligible members into ...