Utilization Management Nurse Consultant - weekend shift

CVS Health; Kentucky; Hybrid; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health in Kentucky is seeking a Registered Nurse for Utilization Management. This full-time weekend position supports two 10-hour shifts on the weekend and two on weekdays, totaling 40 hours per week.

The role involves assessing care options, applying clinical criteria, coordinating with providers, and communicating effectively to ensure appropriate services and benefits. An active KY RN license and 3+ years of clinical experience are required.

Qualifications

• Active, current and unrestricted RN licensure in Kentucky or compact license.
• Minimum 3+ years of clinical experience.
• Proficiency with computers and multiple systems.
• Ability to work a weekend schedule (Sat/Sun and two weekdays).

Responsibilities

• Assess, plan, implement and coordinate utilization/benefit management for members.
• Apply clinical criteria and guidelines to render coverage determinations.
• Communicate with providers to facilitate care and coordinate services.
• Identify opportunities to improve quality and utilization.
• Lend expertise to internal/external stakeholders in utilization management.
• Maintain productivity and quality expectations.

Skills

Clinical experience

Weekend availability

Computer proficiency

Communication skills

Education

RN licensure (KY or multi-state compact)

Associates degree required

Job description

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.

Position Summary

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays and evening hours.

Weekend position - this position will be working two 10-hour shifts on the weekend and two 10-hour shifts on weekdays

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• There are standard productivity and quality expectations.
• Work required the ability to perform close inspection of handwritten and computer generated documents.
• Sedentary work involving periods of sitting, talking, listening.
• Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Effective communication skills, both verbal and written

Required Qualifications

• Must have the ability to work a Weekend position (Sat/Sun + 2 weekdays)
• Must have active, current and unrestricted RN licensure in state of Kentucky or multi state compact RN licensure
• 3+ years of clinical experience
• Position requires proficiency with computer skills which includes navigating multiple systems
• Ability to work in a fast paced environment

Preferred Qualifications

• Previous prior authorization experience

Education

Associates degree required

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

This 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.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/31/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.