Remote Acute Inpatient Utilization Nurse Consultant

4004 Aetna Medicaid Administrators; Louisiana (MO); Hybrid; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking an experienced RN for remote Utilization Management—Concurrent Review in acute inpatient settings. You will evaluate medical necessity, oversee case management, and coordinate with hospitals, physicians, and discharge planners to ensure appropriate care and timely transitions.

Requires an active RN license, 5+ years in acute care, and 2+ years in utilization management or related fields. BSN preferred; remote work with Louisiana residency preferred per guidelines.

Qualifications

• Active RN license in your state
• 5+ years of acute care nursing experience
• 2+ years in Utilization Management or related field
• Experience reviewing acute inpatient admissions and continued stay requests
• Knowledge of MCG or similar evidence-based criteria
• Familiarity with inpatient operations, discharge planning, and care transitions

Responsibilities

• Perform concurrent reviews for acute inpatient admissions and continued hospital stays
• Evaluate medical necessity, severity of illness, and level of care using evidence-based criteria
• Collaborate with hospitals, physicians, care managers, and discharge planners
• Review clinical documentation and apply plan benefits and regulatory requirements
• Partner with Medical Directors on complex cases and escalations
• Facilitate discharge planning and optimize care and resource use

Skills

Active RN license

Acute care nursing

Clinical assessment

Critical thinking

Communication skills

Care coordination

Education

ASN required

BSN preferred

Tools

EMR systems

Utilization management systems

Job description

CVS Health is seeking an experienced RN for remote Utilization Management—Concurrent Review in acute inpatient settings. You will evaluate medical necessity, oversee case management, and coordinate with hospitals, physicians, and discharge planners to ensure appropriate care and timely transitions.

Requires an active RN license, 5+ years in acute care, and 2+ years in utilization management or related fields. BSN preferred; remote work with Louisiana residency preferred per guidelines.