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Weekday Cvs Utilization Management Nurse Jobs (NOW HIRING)

Baptistjax

Baptist Jacksonville is currently hiring for a PRN Utilization Management Nurse to join our Baptist Downtown Location here in the Jacksonville, FL area. This is a PRN role with flexible scheduling ...

MUSC

Utilization Management Nurse-1

Murrells Inlet, SC · On-site

... Nurse required. Prior leadership experience preferred. One year of case management and/or utilization management work experience preferred. Staff hired prior to July 1, 2013 will be grandfathered in ...

Medical University of South Carolina

... Nurse required. Prior leadership experience preferred. One year of case management and/or utilization management work experience preferred. Staff hired prior to July 1, 2013 will be grandfathered in ...

CVS Health

Prior Authorization UM Nurse Consultant

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Utilization Management Nurse Consultant (RN) Remote | Prior Authorization | Louisiana Medicaid ...

CVS Health

Prior Authorization UM Nurse Consultant

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Utilization Management Nurse Consultant (RN) Remote | Prior Authorization | Utilization Management ...

CVS Health

UM Nurse Consultant - Concurrent Review

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Utilization Management Nurse Consultant (RN) - Concurrent Review Remote | Acute Inpatient ...

Humana

Utilization Management Review Nurse

The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. You will be part of a caring ...

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Weekday Cvs Utilization Management Nurse information

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$39K

$89.5K

$163K

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

As of Sep 3, 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 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.

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.

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 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 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

Medical Associates

Dubuque, IA • On-site

Full-time

Medical, Dental, Life, Retirement, PTO

Posted 9 days ago

Job description

Description
Medical Associates is looking for a Utilization Management Nurse to join our Health Care Services team!
Schedule: Primary schedule will be Monday through Friday 8:00am to 5:00pm, 40 hours/week with flexibility. After training, there is opportunity for work from home if desired!
Location: Training is in-person at Medical Associates Health Plans, 1605 Associates Drive, Dubuque, IA 52002
Benefits Package Includes:
  • Single or Family Health Insurance with discounted premium rates for wellness program participation.
  • 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing)
  • Flexible Paid Time Off Program (24 days off/year)
  • Medical and Dependent Care Flex Spending Accounts
  • Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

What You Will Be Doing:
  • Review requests from providers or members for approval of procedures, medications, durable medical and/or services prior to delivery of the service.
  • Utilize established screening criteria to ensure patients get the correct treatment from the resources that are available at the most cost-effective level to meet their needs.
  • Facilitate options and services for meeting individuals' health needs with the goal of decreasing fragmentation, duplication of care and enhancing quality, cost-effective clinical outcomes.
  • Review of hospital and skilled admissions to justify continued care is medically necessary per Health Plan established guidelines.

Essential Functions & Responsibilities:
  1. Conduct reviews inclusive of physician referrals, medication reviews, admissions, utilization review updates, investigating alternatives to hospitalization such as home health care and durable medical equipment, utilizing the assessment process by obtaining pertinent patient history and accurate vital data, anticipating patient and family needs, working with the Health Choice Claims and Membership Services to determine benefit eligibility, facilitating crisis intervention, sharing information with co-workers and documenting accurately. Utilize established screening criteria to determine medical necessity of requested authorizations. Refer patients to case management nurse or health coach as appropriate.
  2. Facilitate out-of-plan referrals, out-of-area urgent and emergent care for enrollees and provider offices and provide necessary information to Medical Director on specified referrals. Communicate decision to enrollees, providers, and facilities per established policies.
  3. Work collaboratively with internal and external staff, in determining extent of benefits and coverage for services being coordinated. Document authorizations, denials, cost savings and other outcome measurements.
  4. Act as a resource for the enrollee, provider offices, and other MAHP departments. Perform retrospective review to determine coverage of hospitalizations, and outpatient services. Communicate with enrollees regarding the use of managed care systems and participate in answering enrollees and providers inquiries.
  5. Assist in preparations for external review/regulatory agencies.
  6. Complete all other assigned projects and duties.

Knowledge, Skills and Abilities:
Experience - Three years to five years of similar or related experience.
Education - Valid RN nursing license is required.
Physical Aspects:
Stooping - Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
Reaching - Extending hand(s) and arm(s) in any direction.
Standing - Particularly for sustained periods of time.
Walking - Moving about on foot to accomplish tasks, particularly for long distances.
Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.
Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.
Grasping - Applying pressure to an object with the fingers and palm.
Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly.
Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.
Vision - 20 / 40 or better in the best eye with or without correction.
Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers.
Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
Environmental Conditions:
None - The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).
Medical Associates Clinic & Health Plans is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, age, national origin, marital status, parental status, disability, veteran status, or other distinguishing characteristics of diversity and inclusion, or any other protected status.Please view Equal Employment Opportunity Posters provided by OFCCP https://www.eeoc.gov/poster

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