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Weekday Cvs Utilization Management Nurse Jobs in Indiana

UHS

MGR - UTILIZATION REVIEW / MGMT

Bloomington, IN · On-site

Must have Registered Nurse license or Master's Degree. Experience: 5-7 yrs acute inpatient ... utilization management for both mental health and substance abuse behavioral health disorders ...

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Reports to the Manager, Utilization Management Department. Serves as a liaison between Memorial ... This position will be deployed from the Summit Center, working closely with nursing supervisors ...

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Reports to the Manager, Utilization Management Department. Serves as a liaison between Memorial ... This position will be deployed from the Summit Center, working closely with nursing supervisors ...

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Reports to the Manager, Utilization Management Department. Serves as a liaison between Memorial ... This position will be deployed from the Summit Center, working closely with nursing supervisors ...

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Weekday Cvs Utilization Management Nurse information

What are the key skills and qualifications needed to thrive as a Weekday CVS Utilization Management Nurse?

To thrive as a Weekday CVS Utilization Management Nurse, you need a valid RN license, strong clinical assessment skills, and experience in case management or utilization review. Familiarity with healthcare management software, insurance guidelines, and medical coding systems such as ICD-10 is typically required. Exceptional critical thinking, attention to detail, and effective communication help nurses advocate for appropriate patient care while collaborating with providers and payers. These skills ensure proper resource utilization, regulatory compliance, and optimal patient outcomes in a managed care setting.

What is the difference between Weekday Cvs Utilization Management Nurse vs Weekend Cvs Utilization Management Nurse?

AspectWeekday Cvs Utilization Management NurseWeekend Cvs Utilization Management Nurse
Work ScheduleMonday to Friday, standard business hoursWeekend shifts, typically Saturday and Sunday
CertificationsRN license, utilization review certification often preferredRN license, utilization review certification often preferred
Work EnvironmentOffice-based, healthcare setting, insurance companyOffice-based, healthcare setting, insurance company
Job ResponsibilitiesReview medical necessity, authorize services, coordinate careReview medical necessity, authorize services, coordinate care

The main difference between Weekday Cvs Utilization Management Nurse and Weekend Cvs Utilization Management Nurse lies in their work schedule. Both roles require similar certifications, responsibilities, and work environments, but the weekday nurse works during standard business hours, while the weekend nurse covers weekend shifts. Both positions are essential for continuous patient care and insurance operations.

What is a Weekday CVS Utilization Management Nurse?

A Weekday CVS Utilization Management Nurse is a registered nurse who works for CVS Health, focusing on evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. This role involves reviewing patient cases, coordinating with healthcare providers, and ensuring that treatments and services meet established guidelines and insurance requirements. These nurses typically work regular weekday hours, rather than nights or weekends. They play a key role in helping patients receive appropriate care while also managing healthcare costs for the organization.

How does a Weekday CVS Utilization Management Nurse typically collaborate with physicians and case managers?

As a Weekday CVS Utilization Management Nurse, you will regularly interact with physicians and case managers to review patient care plans and ensure appropriate resource utilization. This role involves evaluating medical records, discussing treatment options, and providing clinical recommendations to support cost-effective, quality care. Effective communication and teamwork are essential, as you’ll serve as a bridge between clinical staff, patients, and administrative teams to coordinate authorizations and resolve coverage questions.
What are the most commonly searched types of Cvs Utilization Management Nurse jobs in Indiana? The most popular types of Cvs Utilization Management Nurse jobs in Indiana are:
What cities in Indiana are hiring for Weekday Cvs Utilization Management Nurse jobs? Cities in Indiana with the most Weekday Cvs Utilization Management Nurse job openings:
Weekday Cvs Utilization Management Nurse jobs near you
Infographic showing various Weekday Cvs Utilization Management Nurse job openings in Indiana as of August 2026, with employment types broken down into 70% Full Time, and 30% Part Time. Highlights an 90% In-person, and 10% Remote job distribution.

Utilization Management Nurse

SIHO Insurance Services

Columbus, IN

Full-time

Re-posted 13 days ago

Job description

Job Title:  Utilization Management Nurse
Reports To: Manager of Utilization Management
Employment Type:  Full-Time, Exempt 

Brief Description of Duties:     
This position is reserved for a licensed Registered Nurse who will perform the Utilization Management (UM) services for SIHO (and affiliated business lines’) members. This individual’s primary role is to ensure that health care services are administered with quality, cost effectiveness, and compliance to plan guidelines are maintained. By performing review of services prospectively, retrospectively, and throughout the episode of care, the UM nurse will make coverage determinations influencing how services are allocated to SIHO’s various member populations.  A candidate’s ability to perform quality reviews within strict efficiency standards is required for this position.  Key responsibilities are as follows: 
- Pre-service, concurrent, and post-service review of necessity of health care services utilizing enrollee medical records and established guidelines set by SIHO and/or state and federal (CMS) guidelines
- Interaction with the member, health care provider, and/or other care team members to complete reviews in most time-efficient manner
- Interaction with the SIHO Medical Director as needed to ensure proper medical necessity decisions are made in a timely manner
- Appropriate documentation of the entire review process utilizing the established documentation system and desk procedures to guarantee accurate reporting metrics and data integrity
- Complete case review and elevation to determinations that are rendered within the contractual and regulatory turnaround times established by SIHO and CMS
- Assist to resolve problems and provide guidance to members of the team and cohorts
-Interpret and abide by organizational policies and procedures; review work regularly to ensure that policies and guidelines are appropriately applied
-Act as a clinical resource to the department and other organization members for services pertaining to medical management, utilization review, and medical necessity
- Act and perform within the scope of professional nursing practice; is responsible in supporting and participating in department strategies and efforts focused on quality improvement
- Responsible for the early identification and assessment of members for inclusion in disease management or care management programs
- Assist in the identification and reporting of Potential Quality of Care concerns and Fraud, Waste and Abuse incidents
- Work as an interdisciplinary team member within Medical Management for all lines of business and commercial group plans 

Minimum Skills Requirement: 
- Registered Nurse with current, unrestricted license in primary state of employment (position may require additional licensing in other states as necessary)Previous UM or Health Plan experience highly preferred
- Desire to work in a fast-paced environment with focus on efficiency while maintaining quality
- Self-directed organization and prioritization skills, and independent time management skills required
- Sound clinical background with experience in the clinical field
- Excellent verbal and written communication skills
- Microsoft Office Experience: Outlook, Word, Excel

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.