Mid Level Utilization Management Specialist Jobs
Mid level utilization management specialist jobs go to clinicians and analysts ready to own case review workflows, apply independent clinical judgment, and guide teams through complex authorization decisions without constant oversight. Hiring runs across Healthcare & Medical Services, Insurance, and Manufacturing, with a strong mix of remote and on-site positions, and employers like Optum, UF Health, and CVS Health competing for utilization management specialists 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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- Healthcare & Medical Services12
- Insurance6
- Manufacturing1
- Technology & Software1
Mid Level Utilization Management Specialist Jobs: Frequently Asked Questions
How do I get a mid level utilization management specialist job?
Position your experience around independent clinical decision-making, not just task completion. Highlight specific authorization workflows you have owned, criteria sets you have applied such as InterQual or Milliman, and any measurable outcomes you have driven, like denial reduction or turnaround improvement. Tailoring your resume to reflect scope of ownership, rather than a list of duties, is what separates mid level candidates from early-career applicants in this field.
Which companies hire mid level utilization management specialists?
Companies hiring mid level utilization management specialists right now include Optum, UF Health, and CVS Health, based on current listings on Migrate Mate as of August 2026. Health insurers, managed care organizations, and large hospital systems drive the most consistent hiring at this level, often seeking candidates who can work across multiple lines of business or care settings with limited supervision.
Are there remote mid level utilization management specialist jobs?
Yes, and the share is substantial for this role. About 64% of mid level utilization management specialist openings are remote or hybrid as of August 2026, reflecting how much of this work, including chart reviews, authorization determinations, and payer communication, can be performed entirely outside a clinical facility. Fully remote roles typically require reliable internet access and familiarity with care management platforms.
How do I move up to a mid level utilization management specialist role?
Getting to mid level means building depth in clinical criteria application, showing you can manage a caseload independently, and producing outcomes your team can point to. Over your first few years, seek exposure to different care settings, learn multiple utilization review criteria systems, and take ownership of quality or audit projects. Demonstrating that you flag issues proactively and influence decisions, rather than just executing instructions, is what earns mid level consideration.
Which industries hire the most mid level utilization management specialists?
Mid Level utilization management specialist 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 utilization management sits at the intersection of clinical care and cost containment, functions that health plans, managed care firms, and integrated delivery networks all need to staff with experienced, decision-ready clinicians rather than entry-level reviewers.