Arizona, United States · Hybrid
$61k–$130k/yr
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…
Skills: Utilization management, Clinical quality, Compliance, Audit support, Regulatory submission
Plymouth Meeting, Pennsylvania, United States · On-site
$16/hr–$24/hr
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…
Skills: Deductive reasoning, Analytical skills, Computer skills, Communication skills, Supervision
Valrico, Florida, United States · On-site
$60/hr–$76/hr
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…
Skills: Pharmacy operations, Patient counseling, Immunization, Prescription fulfillment, Inventory management
Glen Cove, New York, United States · On-site
$19/hr–$29/hr
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…
Skills: Pharmacy operations, Prescription fulfillment, Customer service, Immunization administration, Inventory management
Los Angeles, California, United States · On-site
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…
Skills: Customer service, Cashiering, Inventory management, Communication, Attention to detail
Bedford, Virginia, United States · On-site
$60/hr–$76/hr
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…
Skills: Pharmacy operations, Patient safety, Regulatory compliance, Quality assurance, Customer service
Raleigh, North Carolina, United States · On-site
$17/hr–$28/hr
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…
Skills: Pharmacy technician, Data entry, Customer service, Medication dispensing, Dosage calculation
Waverly, New York, United States · On-site
$17/hr–$25/hr
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…
Skills: Forklift operation, Pallet jack operation, Reach truck operation, Bulk case picking, Safety compliance
Woonsocket, Rhode Island, United States · Hybrid
$118k–$261k/yr
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…
Skills: Site Reliability Engineering, Observability, Kubernetes, Chaos Engineering, Incident Management
Pennsylvania, United States · Remote Solely
$61k–$130k/yr
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…
Skills: Case management, Care planning, Clinical nursing, Motivational interviewing, Care coordination
Hartford, Connecticut, United States · Hybrid
$90k–$199k/yr
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…
Skills: Strategic planning, Management consulting, Financial analysis, Market research, Competitive intelligence
Isle of Hope, Georgia, United States · On-site
$18/hr–$31/hr
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…
Skills: Hardware troubleshooting, Hardware maintenance, Hardware repair, Technical support, System procedures
Winnipeg, Manitoba, Canada · Hybrid
$75k–$166k/yr
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…
Skills: Human resources, Strategic planning, Organizational effectiveness, Change management, Employee relations
Island, Kentucky, United States · Remote OK
$66k–$146k/yr
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…
Skills: SQL, Snowflake, GCP, Tableau, Power BI
Bradenton, Florida, United States · On-site
$15/hr–$19/hr
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…
Skills: Customer service, Cashiering, Inventory management, Communication, Attention to detail
Lodi, California, United States · On-site
$16/hr–$23/hr
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…
Skills: Customer service, Cashiering, Inventory management, Retail operations, Communication
Long Beach, California, United States · On-site
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…
Skills: Leadership, Customer service, Deductive reasoning, Analytical skills, Computer skills
Moline, Illinois, United States · On-site
$18/hr–$35/hr
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…
Skills: Sales, Lead generation, Relationship management, Cold calling, Networking
Riverview, Florida, United States · On-site
$16/hr–$25/hr
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…
Skills: Pharmacy operations, Prescription fulfillment, Customer service, Active listening, Mathematical reasoning
Fort Valley, Georgia, United States · On-site
$15/hr–$18/hr
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…
Skills: Customer service, Cashiering, Inventory management, Sales floor maintenance, Communication
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The clinician will lead and support audit, accreditation, and regulatory submission activities to ensure utilization management operations meet quality and compliance standards. They will also analyze compliance trends and partner with cross-functional teams to drive process excellence and operational performance.
Candidates must hold an active, unrestricted RN license and have at least 5 years of experience in healthcare operations, utilization management, or clinical quality. An associate degree in nursing is required, with preference given to those with BSN degrees and NCQA accreditation experience.
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.
This role has a strong compliance, quality, and operational focus, so the posting should emphasize impact, cross-functional collaboration, and the opportunity to drive quality outcomes.
Are you a detail-oriented RN with a passion for quality, compliance, and operational excellence? Join our team and play a key role in ensuring utilization management processes meet regulatory, accreditation, and quality standards that support exceptional member care.
In this highly visible role, you'll help strengthen operational quality, improve compliance performance, and support safe, high-quality care for members through disciplined execution, collaboration, and continuous improvement.
Anticipated Weekly Hours
40The typical pay range for this role is:
$60,522.00 - $129,615.00This 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.
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Simplifying health care one person, one family and one community at a time
CVS Health is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by simplifying health care one person, one family and one community at a time. Follow @CVSHealth on social media.
Offices: 1 CVS Drive, Woonsocket, RI 02895, US · 9501 E. Shea Blvd, Scottsdale, AZ 85260, US · 2211 Sanders Road, Northbrook, IL 60062, US · 750 West John Carpenter Freeway, Ste 1200, Irving, TX 75039, US · 620 Epsilon Dr, Pittsburgh, PA 15238, US
Simplifying health care one person, one family and one community at a time
CVS Health is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by simplifying health care one person, one family and one community at a time. Follow @CVSHealth on social media.
Offices: 1 CVS Drive, Woonsocket, RI 02895, US · 9501 E. Shea Blvd, Scottsdale, AZ 85260, US · 2211 Sanders Road, Northbrook, IL 60062, US · 750 West John Carpenter Freeway, Ste 1200, Irving, TX 75039, US · 620 Epsilon Dr, Pittsburgh, PA 15238, US
