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Weekday Cvs Utilization Management Nurse Jobs in Rochester, NY

Highland Hospital

RN Case Manager (Hospital)

Rochester, NY · On-site

$77K - $93K/yr

... utilization management, proactive patient management, care facilitation and treatment planning functions. The Clinical Care Coordinator/Care Manager coordinates care along with unit staff (Nursing ...

Highland Hospital

RN Case Manager PC/FM

Rochester, NY · On-site

$37 - $45/hr

... utilization management, proactive patient management, care facilitation and treatment planning functions. The RN Care Manager manages clinical aspects of patient centered medical home, working with ...

Rochester Regional Health

Care Manager-RN

Rochester, NY · On-site

$82K - $113K/yr

Three (3) years of acute hospital care, case management or utilization management experience ... Registered Nurse license in New York State. * Basic Life Support (BLS) certification. PREFERRED ...

Rochester Regional Health

Care Manager-RN

Irondequoit, NY · On-site

$82K - $113K/yr

Three (3) years of acute hospital care, case management or utilization management experience ... Registered Nurse license in New York State. * Basic Life Support (BLS) certification. PREFERRED ...

Highland Hospital

NURSE MANAGER - SE6

Rochester, NY · On-site

$105K - $137K/yr

... resource management, assessment and monitoring of resource needs and utilization, staff ... The Nurse Manager represents the unit and service on committees at all levels within the ...

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All JobsWeekday Cvs Utilization Management Nurse JobsWeekday Cvs Utilization Management Nurse Jobs in Rochester, NY

Weekday Cvs Utilization Management Nurse information

See Rochester, NY salary details

$38.5K

$88.3K

$160.8K

How much do weekday cvs utilization management nurse jobs pay per year?

As of Aug 11, 2026, the average yearly pay for weekday cvs utilization management nurse in Rochester, NY is $88,290.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,600.00 and $103,100.00 per year, depending on experience, location, and employer.

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 Rochester, NY? The most popular types of Cvs Utilization Management Nurse jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Weekday Cvs Utilization Management Nurse jobs? Cities near Rochester, NY with the most Weekday Cvs Utilization Management Nurse job openings:
Weekday Cvs Utilization Management Nurse jobs near you

RN Case Manager (Hospital)

Highland Hospital

Rochester, NY • On-site

$77K - $93K/yr

Other

Re-posted 4 days ago

Highland Hospital (New York) rating

7.7

Company rating: 7.7 out of 10

Based on 24 frontline employees who took The Breakroom Quiz

221st of 1,056 rated hospitals

Job description

18562BR

Title:

RN Case Manager (Hospital)

Department/Cost Center:

771 - Social Work Service

Job Description:

Highland Hospital is seeking a part-time Case Manager to join the team. Hours will be Monday-Friday from 8am-4:30pm.

Under general direction, the Clinical Care Coordinator/Case Manager's role is to coordinate interdisciplinary care planning to achieve timely and safe discharge and/or to coordinate access and utilization management, proactive patient management, care facilitation and treatment planning functions. The Clinical Care Coordinator/Care Manager coordinates care along with unit staff (Nursing, Providers, Consulting Services, Social Work) and providers caring for the patient at discharge to assist in facilitating a patient focused plan of care aimed at ensuring a safe transition from hospital to home for adult acute care patients.

Essential functions include, but are not limited to:

  • Identify patient discharge needs and potential barriers
  • Assists with closing gaps in medical care upon discharge by utilizing community resources
  • Communication with in-network PCP offices to ensure a transition of care to the community setting
  • Identify resources for patient self-management planning and discharge
  • Assist in developing and implementing care plans for medically complex patients
  • Prepares patient for discharge by referring for home care services (skilled nursing, PT, OT, SLP) and DME
  • Complete the Patient Review Instrument
  • Other duties as assigned

Salary Range:

$77,220.15- $93,600

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations

Auto req ID:

18562BR

Job Requirements:

  1. Fulfilled the educational requirements to be a licensed RN in NYS; BSN preferred. 3-5 years professional nursing experience. Progressive clinical experience including community health, care management, and/or disease management is preferred.

  2. Experience working as a member of a multi-disciplinary team is required. Experience in data analysis and chronic illness management preferred.

  3. Current and valid license to practice as an RN in New York State required. PRI certification preferred but not required.

Employment Status:

Part-Time

Hours/Week:

20 hours/week

Posting Title:

RN Care Coordinator

City:

Rochester

Work Shift:

Days

Area of Interest:

Nurses

The Hospital is committed to equal opportunity for all persons regardless of age, color, disability, ethnicity, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by law.

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