Utilization Management Nurse Jobs in Pennsylvania
Utilization Management Nurse jobs in Pennsylvania are consistently in demand, concentrated in health insurance, managed care, and large integrated health systems serving one of the country's most densely populated states, with openings at every level from staff reviewer through senior clinical coordinator. The most active hiring metros are Philadelphia, Pittsburgh, and Harrisburg, where employers such as Independence Blue Cross, UPMC, and Highmark Health maintain large utilization management teams. Case management review, prior authorization, and discharge planning are the specialties drawing the most consistent interest from Pennsylvania employers. Find a role that fits below and apply directly.
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Showing 5 of 7+ 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.
- Schedule:
This is an Alternative Work Schedule weekend position. The role requires coverage of both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage.
Position Summary:
Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
Key Responsibilities:
- Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care.
- Communicate with providers and other parties to facilitate care and treatment. Identify members for referral opportunities to integrate with other products, services, or benefit programs.
- Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Meet set productivity and quality expectations as established by UMNC.
Required Skills and Abilities:
- Effective verbal and written communication skills.
- Proficiency with computer skills, including navigating multiple systems and keyboarding.
- Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.
- Capacity to sit for extended periods, talk on the telephone, and type on the computer.
Work Location:
This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed.
`Required Qualifications
Registered Nurse
Education: Diploma RN acceptable; Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience
Must have active current and unrestricted RN licensure in state of residence.
May be required to obtain additional Nursing Licenses as business needs require.
- Preferred Qualifications
- Utilization Management experience preferred
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: 09/02/2026
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.
- Schedule:
This is an Alternative Work Schedule weekend position. The role requires coverage of both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage.
Position Summary:
Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
Key Responsibilities:
- Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care.
- Communicate with providers and other parties to facilitate care and treatment. Identify members for referral opportunities to integrate with other products, services, or benefit programs.
- Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Meet set productivity and quality expectations as established by UMNC.
Required Skills and Abilities:
- Effective verbal and written communication skills.
- Proficiency with computer skills, including navigating multiple systems and keyboarding.
- Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.
- Capacity to sit for extended periods, talk on the telephone, and type on the computer.
Work Location:
This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed.
`Required Qualifications
Registered Nurse
Education: Diploma RN acceptable; Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience
Must have active current and unrestricted RN licensure in state of residence.
May be required to obtain additional Nursing Licenses as business needs require.
- Preferred Qualifications
- Utilization Management experience preferred
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: 09/02/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
See All 7 Utilization Management Nurse Jobs in Pennsylvania
Find roles in Pennsylvania that match your experience and apply in just a few clicks.
Find JobsUtilization Management Nurse Jobs by City in Pennsylvania
Where Pennsylvania roles are concentrated, by current openings.
Utilization Management Nurse Job Market in Pennsylvania
A snapshot from current Pennsylvania openings, updated as new roles post.
Who's Hiring
Top Industries Hiring
- Technology & Software
What Pennsylvania Employers Look For
The qualifications that appear most often in utilization management nurse jobs across Pennsylvania.
- Active registered nurse license issued or recognized by the Pennsylvania State Board of Nursing
- Associate or bachelor's degree in nursing from an accredited program required
- Minimum two to three years of clinical nursing experience in an acute care or managed care setting
- Working knowledge of InterQual or Milliman criteria for clinical review and authorization decisions
- Certified Case Manager or Accredited Case Manager certification preferred by most Pennsylvania employers
- Proficiency with electronic health records and utilization management platforms such as Utilization Review Accreditation Commission standards
Utilization Management Nurse Jobs in Pennsylvania: Frequently Asked Questions
How do you become a utilization management nurse in Pennsylvania?
You must first hold an active registered nurse license issued by the Pennsylvania State Board of Nursing, which requires passing the NCLEX-RN exam after completing an accredited associate or bachelor's degree nursing program. From there, most Pennsylvania employers expect at least a few years of clinical experience before moving into utilization management. Pursuing a Certified Case Manager credential strengthens your candidacy and is increasingly expected by larger health systems and insurers in the state.
Which companies hire utilization management nurses in Pennsylvania?
Employers hiring utilization management nurses in Pennsylvania right now include CVS Health, IntePros, and AbsoluteCare, based on current listings on Migrate Mate as of August 2026. Pennsylvania's dense concentration of integrated health systems and regional insurers means utilization management roles appear across both payer and provider sides of the market.
Which Pennsylvania cities have the most utilization management nurse jobs?
Pennsylvania, Philadelphia, and Meadville lead Pennsylvania for utilization management nurse openings. Philadelphia anchors the southeast with the headquarters of major insurers like Independence Blue Cross alongside Jefferson Health and Penn Medicine, while Pittsburgh's concentration around UPMC and Highmark Health drives strong demand there, and Harrisburg draws openings tied to state government health programs and regional managed care organizations.
Are there remote utilization management nurse jobs in Pennsylvania?
Yes, and more than most nursing roles. Because utilization management work centers on chart review, prior authorization, and care coordination rather than hands-on patient care, it translates well to remote settings. About 60% of utilization management nurse openings tied to Pennsylvania are remote or hybrid as of August 2026, reflecting the desk-based nature of the work. Prior authorization review and telephonic case management are the functions most commonly offered as fully remote positions.
How can I get hired as a utilization management nurse in Pennsylvania with little or no experience?
The most realistic entry path is lateral movement from a clinical case manager, discharge planner, or care coordinator role within a Pennsylvania hospital system such as UPMC, Jefferson Health, or Penn Medicine, where internal transfers into utilization management are common. Completing a Certified Case Manager credential while still in a bedside or care coordination role signals readiness to hiring managers. Some regional insurers in Pennsylvania also post junior utilization review positions that accept candidates with strong acute care backgrounds and train on-the-job for criteria application.
Where can I find and apply to utilization management nurse jobs in Pennsylvania?
You can find and apply to utilization management nurse jobs in Pennsylvania on Migrate Mate, which lists current Pennsylvania openings from health systems, insurers, and managed care organizations across the state. Find roles that fit your experience and specialty focus, then apply directly to the employer.
See All 7 Utilization Management Nurse Jobs in Pennsylvania
Find roles in Pennsylvania that match your experience and apply in just a few clicks.
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