Remote Utilization Management Nurse Consultant

CVS Health Corporation; Louisiana; 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 experienced Utilization Management Nurse Consultant (RN) to perform concurrent reviews for acute inpatient admissions, ensuring high-quality, cost-effective care.

You will evaluate medical necessity and level of care using evidence-based criteria, collaborate with hospitals, care managers, and discharge planners, and support timely transitions of care. This full-time remote role is based in Louisiana.

Qualifications

• ASN required; BSN preferred.
• 5+ years of acute care nursing experience.
• 2+ years in Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review.
• Active, unrestricted RN license in your state of residence; ability to obtain additional licensure as needed.

Responsibilities

• Perform concurrent reviews for acute inpatient admissions and continued hospital stays.
• Evaluate medical necessity, severity of illness, intensity of service, and level of care using evidence-based clinical criteria.
• Collaborate with hospitals, physicians, care managers, and discharge planners to support appropriate treatment and timely transitions of care.
• Review clinical documentation and apply health plan benefits and regulatory requirements to authorization decisions.
• Partner with Medical Directors on complex cases and escalations.
• Facilitate discharge planning and identify opportunities to optimize care and resource utilization.
• Manage a high-volume caseload while meeting quality, productivity, and turnaround-time standards.

Skills

Acute care nursing

Utilization management

Care coordination

Discharge planning

Education

ASN

BSN

Job description

CVS Health is seeking an experienced Utilization Management Nurse Consultant (RN) to perform concurrent reviews for acute inpatient admissions, ensuring high-quality, cost-effective care.

You will evaluate medical necessity and level of care using evidence-based criteria, collaborate with hospitals, care managers, and discharge planners, and support timely transitions of care. This full-time remote role is based in Louisiana.