Utilization Management Nurse Jobs in New York
Utilization management nurse jobs in New York are among the most active in the country, concentrated in health insurance and managed care, large hospital systems, and government health programs, with openings at every level from entry-level case reviewers through senior clinical advisors. New York City, Albany, and Buffalo are the primary hiring hubs, anchored by well-known employers such as EmblemHealth, Northwell Health, and MetroPlus Health. Medical necessity review, care coordination, and behavioral health utilization are the most in-demand specialties across the state. Find a role that fits below and apply directly.
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Showing 5 of 15+ Utilization Management Nurse jobs
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 is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
UM Nurse Consultant
Fully Remote- WFH
M-F 8a-5p EST/9a-6p CST With 1 hour lunch
Position Summary
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
3+ years of experience as an RN
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
Prior authorization/utilization management experience
Outpatient Clinical experience
Knowledge of Medicare/Medicaid
Managed care experience
Education
Associates Degree in Nursing required
BSN preferred
Work from Home Requirements:
- You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and
a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
- A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS
Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
- The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own
workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
- If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.
Technical and Logistical Requirements:
- Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications
simultaneously to streamline tasks and improve efficiency.
- Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and
virtual meetings.
- Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or
similar (Google Workspace).
- Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when
unattended, manage strong passwords, and recognize suspicious emails or links.
- Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when
frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
- Future Growth: Openness to learning new skills in the future as the workplace environment evolves
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$26.01 - $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 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: 08/29/2026
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 is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
UM Nurse Consultant
Fully Remote- WFH
M-F 8a-5p EST/9a-6p CST With 1 hour lunch
Position Summary
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
3+ years of experience as an RN
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
Prior authorization/utilization management experience
Outpatient Clinical experience
Knowledge of Medicare/Medicaid
Managed care experience
Education
Associates Degree in Nursing required
BSN preferred
Work from Home Requirements:
- You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and
a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
- A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS
Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
- The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own
workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
- If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.
Technical and Logistical Requirements:
- Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications
simultaneously to streamline tasks and improve efficiency.
- Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and
virtual meetings.
- Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or
similar (Google Workspace).
- Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when
unattended, manage strong passwords, and recognize suspicious emails or links.
- Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when
frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
- Future Growth: Openness to learning new skills in the future as the workplace environment evolves
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$26.01 - $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 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: 08/29/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
See All 15 Utilization Management Nurse Jobs in New York
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Find JobsUtilization Management Nurse Jobs by City in New York
Where New York roles are concentrated, by current openings.
Utilization Management Nurse Job Market in New York
A snapshot from current New York openings, updated as new roles post.
Who's Hiring
Top Industries Hiring
- Insurance
- Healthcare & Medical Services
What New York Employers Look For
The qualifications that appear most often in utilization management nurse jobs across New York.
- Active New York State Registered Nurse license in good standing required
- Minimum two to three years of clinical nursing experience in an acute care or managed care setting
- Working knowledge of InterQual or Milliman clinical criteria for medical necessity review
- Certified Case Manager credential or Accredited Case Manager designation strongly preferred
- Experience conducting prior authorization, concurrent review, or discharge planning determinations
- Proficiency with electronic health records and utilization management documentation platforms
Utilization Management Nurse Jobs in New York: Frequently Asked Questions
How do you become a utilization management nurse in New York?
Start by holding an active New York State Registered Nurse license, which is issued by the New York State Education Department's Office of the Professions after passing the NCLEX-RN. Most employers require at least two years of clinical bedside experience in an acute, specialty, or managed care setting before hiring into a utilization management role. Adding a Certified Case Manager credential strengthens your application significantly and is often listed as preferred in New York job postings.
Which companies hire utilization management nurses in New York?
Employers hiring utilization management nurses in New York right now include Nascentia Health, MetroPlusHealth, and CVS Health, based on current listings on Migrate Mate as of August 2026. New York's large managed care and insurance market means health plans, Medicaid managed care organizations, and integrated health systems are consistently among the most active sources of these openings.
Which New York cities have the most utilization management nurse jobs?
New York, New York State, and Rome have the most utilization management nurse openings in New York. New York City dominates due to its concentration of national health insurers, large Medicaid managed care plans, and major academic medical centers, while Albany's volume is driven by state government health programs and regional insurance carriers, and Buffalo's openings come from systems like Kaleida Health and local managed care organizations.
Are there remote utilization management nurse jobs in New York?
Yes, and more than most nursing roles, since utilization management work is largely desk-based and involves reviewing records and conducting phone-based clinical consultations rather than hands-on patient care. About 100% of utilization management nurse openings tied to New York are remote or hybrid as of August 2026, reflecting how well-suited the role is to distributed work. Prior authorization and retrospective review functions are the most commonly posted as fully remote.
How can I get hired as a utilization management nurse in New York with little or no experience?
The most realistic entry path is transitioning from a clinical bedside role into case management or care coordination first, since New York employers rarely hire into utilization management without some acute or specialty nursing background. Large systems like Northwell Health and NYC Health and Hospitals run new-grad residency programs that build the clinical foundation you will need. Earning your New York RN license and completing even one year in a med-surg, telemetry, or managed care environment positions you for an entry-level utilization review associate role.
Where can I find and apply to utilization management nurse jobs in New York?
You can find and apply to utilization management nurse jobs in New York on Migrate Mate, which lists current openings from employers hiring in the state right now. Search for roles that match your experience and credentials, then apply directly to the ones that fit.
See All 15 Utilization Management Nurse Jobs in New York
Find roles in New York that match your experience and apply in just a few clicks.
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