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Weekday Cvs Utilization Management Nurse Jobs (NOW HIRING)

HealthONE

Utilization Management Nurse

Dalton, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Job Title Utilization Management Nurse The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms.

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $56.14/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... N licensure in state of residence Utilization Management is a 24/7 operation and work schedules ...

Intus Care

Contract Utilization Management Nurse

$42/hr

Contract Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care ...

Access Dubuque

Utilization Management Nurse

Dubuque, IA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Management Nurse Cottingham & Butler/ SISCO 1 Positions ID: 4627707008 Posted On 07/01/2025 Refreshed On 07/15/2026 Job Overview Utilization Management Nurse Location : Onsite in Dubuque ...

CVS Health

Utilization Management Nurse Consultant-1

New York, NY · On-site

$26.01 - $74.78/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... N licensure in state of residence - Utilization Management is a 24/7 operation and work schedules ...

New

Intus, Inc

Contract Utilization Management Nurse

$42/hr

Role Overview The Contract Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This ...

INTUS INC

Contract Utilization Management Nurse

$42/hr

Role Overview The Contract Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This ...

Oak St. Health

Utilization Management Nurse Consultant-1

$26.01 - $74.78/hr

Join Us At Cvs Health We're building a world of health around every individual -- shaping a more ... N licensure in state of residence. Utilization Management is a 24/7 operation and work schedules ...

New

Oak St. Health

Utilization Management Nurse Consultant-1

$26.01 - $74.78/hr

Join Us At Cvs Health We're building a world of health around every individual -- shaping a more ... N licensure in state of residence. Utilization Management is a 24/7 operation and work schedules ...

New

Oak St. Health

Utilization Management Nurse Consultant-1

$26.01 - $74.78/hr

Join Us At Cvs Health We're building a world of health around every individual -- shaping a more ... N licensure in state of residence. Utilization Management is a 24/7 operation and work schedules ...

New

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All JobsWeekday Cvs Utilization Management Nurse Jobs

Weekday Cvs Utilization Management Nurse information

See salary details

$39K

$89.5K

$163K

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

As of Aug 14, 2026, the average yearly pay for weekday cvs utilization management nurse in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 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 cities are hiring for Weekday Cvs Utilization Management Nurse jobs?

Cities with the most Weekday Cvs Utilization Management Nurse job openings:

What are the most commonly searched types of Cvs Utilization Management Nurse jobs?

The most popular types of Cvs Utilization Management Nurse jobs are:

What states have the most Weekday Cvs Utilization Management Nurse jobs?

States with the most job openings for Weekday Cvs Utilization Management Nurse jobs include:

Weekday Cvs Utilization Management Nurse jobs near you

Utilization Management Nurse

HealthONE

Dalton, GA • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 23 days ago

Job description

Job Title

Utilization Management Nurse

Job Description

The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms.

Essential Job Duties
  • Initiate referrals to ensure appropriate coordination of care.
  • Seek the advice of the Medical Director when appropriate, according to policy.
  • Assists non-clinical staff in performance of administrative reviews.
  • Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility.
  • Regular and predictable attendance.
  • Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice.
  • Works to encourage and promote Company culture throughout the organization.
  • Other duties as may be assigned
Qualifications
  • 3 years Clinical experience preferred
  • 1-2 years of Utilization Review preferred
  • Proficient in Microsoft Office (Outlook, Word, Excel)
  • Working knowledge of NCQA preferred
  • Must be able to work in an independent and creative manner.
  • Ability to manage multiple projects and priorities
  • Adaptive to high pace and changing environment
  • Customer service oriented
  • Proficient in interpreting benefits, contract language and medical policy/medical review criteria
  • Current, active Compact State license in Nursing (RN)
Physical Requirements

Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

Benefits
  • 401K (4% Match, Immediate Vesting)
  • Accident insurance
  • Competitive salary
  • Critical Illness Insurance
  • Dental Insurance
  • Employee Assistance Program
  • Flexible Spending Account
  • Health & Wellness Program
  • Health Savings Account
  • Life & AD&D Insurance
  • Long Term Disability
  • Medical Insurance
  • Paid Time Off
  • Pet Insurance
  • Short Term Disability
  • Vision Insurance
Pre-Employment Screening

Drug Screen and Background Check Required

Company Statement

HealthOne is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.

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