Mid Level Utilization Management Nurse Jobs
Mid level utilization management nurse jobs go to nurses ready to own case review workflows, guide less experienced peers, and make coverage determinations with minimal oversight. Openings run across Healthcare & Medical Services, Insurance, and Manufacturing, with 64% remote or hybrid availability and employers like Optum, UF Health, and CVS Health hiring at this level now.
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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.
Utilization Management Nurse Consultant Clinical Precertification RN (Medicare)
Remote | Full-Time | Weekday Schedule
Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time.
What You’ll Do
- Review clinical cases and make coverage determinations using evidence-based guidelines
- Collaborate with providers and care teams to coordinate appropriate treatment
- Apply clinical judgment to support utilization and benefit management decisions
- Identify opportunities to improve care quality and member outcomes
- Serve as a clinical resource across internal and external stakeholders
What You Bring - REQUIRED
- Active, unrestricted RN license in the state of residence.
- 3+ years of RN experience, including 1+ year in Med/Surg
- Strong clinical assessment and decision-making skills
- Experience with Microsoft Office (Outlook, Teams, Excel)
- Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
- Associate Degree in Nursing
Nice to Have
- Utilization Management or Prior Authorization experience
- Managed care background
- Familiarity with MedCompass
- Ambulatory surgery experience
- BSN preferred
Why Join Us?
- Transition your clinical skills into a collaborative, non-bedside role
- Make a meaningful impact on patient care and outcomes
- Work in a supportive, team-driven environment
If you’re passionate about combining clinical expertise with care coordination and healthcare quality, we’d love to hear from you!
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.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 08/19/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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.
Utilization Management Nurse Consultant Clinical Precertification RN (Medicare)
Remote | Full-Time | Weekday Schedule
Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time.
What You’ll Do
- Review clinical cases and make coverage determinations using evidence-based guidelines
- Collaborate with providers and care teams to coordinate appropriate treatment
- Apply clinical judgment to support utilization and benefit management decisions
- Identify opportunities to improve care quality and member outcomes
- Serve as a clinical resource across internal and external stakeholders
What You Bring - REQUIRED
- Active, unrestricted RN license in the state of residence.
- 3+ years of RN experience, including 1+ year in Med/Surg
- Strong clinical assessment and decision-making skills
- Experience with Microsoft Office (Outlook, Teams, Excel)
- Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
- Associate Degree in Nursing
Nice to Have
- Utilization Management or Prior Authorization experience
- Managed care background
- Familiarity with MedCompass
- Ambulatory surgery experience
- BSN preferred
Why Join Us?
- Transition your clinical skills into a collaborative, non-bedside role
- Make a meaningful impact on patient care and outcomes
- Work in a supportive, team-driven environment
If you’re passionate about combining clinical expertise with care coordination and healthcare quality, we’d love to hear from you!
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.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 08/19/2026
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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Top Industries Hiring
- Healthcare & Medical Services12
- Insurance6
- Manufacturing1
- Technology & Software1
Mid Level Utilization Management Nurse Jobs: Frequently Asked Questions
How do I get a mid level utilization management nurse job?
Position yourself around clinical decision-making and independent case management. Highlight experience conducting prior authorization reviews, applying InterQual or Milliman criteria, and coordinating with multidisciplinary teams. Emphasize situations where you owned a caseload or process without heavy supervision. Certifications like the Certified Case Manager credential strengthen applications, and demonstrating measurable outcomes from your reviews will set you apart from candidates who list only duties.
Which companies hire mid level utilization management nurses?
Companies hiring mid level utilization management nurses right now include Optum, UF Health, and CVS Health, based on current listings on Migrate Mate as of August 2026. Hiring at this level is concentrated among managed care organizations, health insurance plans, and large hospital systems building out their care management and cost-containment functions.
Are there remote mid level utilization management nurse jobs?
Yes, and utilization management is one of the more remote-accessible nursing specialties given its chart-based and telephonic nature. About 64% of mid level utilization management nurse openings are remote or hybrid as of August 2026, making it a strong option for nurses seeking flexibility without stepping away from clinical decision-making work.
How do I move up to a mid level utilization management nurse role?
The path into mid level typically runs through bedside or case management experience where you build comfort reading clinical documentation and applying medical necessity criteria. Over time, taking on more complex cases, seeking exposure to payer-side reviews, and earning a certification in case management or utilization review signals readiness. Demonstrating ownership of outcomes rather than just completing tasks is what separates mid level candidates from entry-level applicants.
Which industries hire the most mid level utilization management nurses?
Mid Level utilization management nurse roles concentrate in Healthcare & Medical Services, Insurance, and Manufacturing, based on current listings on Migrate Mate as of August 2026. These sectors drive demand because they carry the greatest need for clinical review functions that control costs, meet regulatory requirements, and ensure appropriate levels of care across large member or patient populations.