Weekend Utilization Management RN Consultant

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

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.