Utilization Management Nurse Consultant - weekend shift

CVS Health; United States; Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an RN for Utilization Management with a weekend schedule. The role involves assessing and coordinating care, applying clinical criteria, and communicating with providers to ensure appropriate services and benefits.

Requires an active RN license (KY or compact) and 3+ years of clinical experience; proficiency with EMR systems and navigating multiple platforms is expected. Full-time position with a comprehensive benefits package.

Qualifications

• Must have ability to work a Weekend position (Sat/Sun + 2 weekdays).
• Active, current and unrestricted RN licensure in Kentucky or multi-state license.
• 3+ years of clinical experience.
• Proficiency with computer skills including navigating multiple systems.
• Ability to work in a fast paced environment.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate healthcare services for members.
• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care and identify referral opportunities.
• Promote quality use of healthcare services and benefits.
• Consult with internal and external constituents in utilization/benefit management.

Skills

RN licensure

Clinical experience

Computer skills

Fast-paced environment

Weekend schedule

Education

Associate's degree

BSN preferred

Tools

EMR software

Navigate multiple systems

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 ourselvesaccountable 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/recommendationalong 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 requires 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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

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.