UM Nurse Consultant

4004 Aetna Medicaid Administrators; Louisiana (MO); Hybrid; USD 52,000 - 117,000; Full time

Benefits offered by this job

Remote work

Medical, dental, vision coverage

Paid time off

Job summary

CVS Health is seeking an experienced radi-? nurse for a 100% remote Concurrent Review RN position. The role supports inpatient reviews, discharge planning, and care transitions across the continuum.

Required is an active Louisiana RN license (or Compact), with 5+ years of inpatient nursing experience and strong clinical assessment. You must be willing to obtain additional state licensure and participate in weekend/holiday on-call rotations.

Qualifications

• Active RN license in Louisiana or Compact license.
• Willing to obtain additional state licensure as required.
• 5+ years of inpatient clinical nursing experience.
• Strong clinical assessment, critical-thinking, and communication skills.
• Willing to participate in rotating weekend and holiday on-call schedules.

Responsibilities

• Conduct concurrent reviews for inpatient admissions and continued stays.
• Evaluate clinical documentation and determine medical necessity using guidelines.
• Collaborate with hospitals, physicians, utilization review, and care teams.
• Facilitate timely discharge planning and care transitions.
• Monitor inpatient treatment and identify opportunities to improve utilization and outcomes.
• Communicate recommendations and findings to providers and stakeholders.
• Support resource utilization while maintaining quality and compliance.

Skills

RN license

Louisiana license

5+ years inpatient

Critical thinking

Communication skills

Weekend on-call

Education

Associates Degree

Bachelor’s degree preferred

Job description

Concurrent Review Nurse (RN) 100% Remote | Monday-Friday, 8:00 AM-5:00 PM CST Occasional Weekend & Holiday On-Call Coverage

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.

Are you an experienced inpatient Registered Nurse looking to transition into a remote role where you can use your clinical expertise to influence patient care across the continuum? Join our Concurrent Review team and help ensure members receive appropriate, high-quality, and cost-effective healthcare services.

What You’ll Do

• Conduct concurrent reviews for inpatient admissions and continued stays
• Evaluate clinical documentation and determine medical necessity using established guidelines and evidence-based criteria
• Collaborate with hospitals, physicians, utilization review departments, and care teams to support appropriate levels of care
• Facilitate timely discharge planning and care transitions
• Monitor ongoing inpatient treatment and identify opportunities to improve healthcare utilization and outcomes
• Communicate recommendations and clinical findings to providers and internal stakeholders
• Support effective resource utilization while maintaining quality and compliance standards

WHAT YOU BRING - REQUIRED

• Active, unrestricted RN license with Louisiana licensure or Compact RN licensure
• Ability and willingness to obtain additional state licensure as required
• 5+ years of inpatient clinical nursing experience
• Strong clinical assessment, critical-thinking, and communication skills
• Ability to participate in rotating weekend coverage and holiday on-call schedules

Preferred Qualifications

• Utilization Management or Concurrent Review experience
• Experience using MCG (Milliman Care Guidelines) and/or InterQual
• Acute inpatient discharge planning experience
• Managed Care experience

Schedule

Monday-Friday, 8:00 AM-5:00 PM CST Occasional rotating weekend coverage Rotating holiday on-call responsibilities

Education

Associates Degree required, Bachelors preferred

Why Join Us?

• Fully remote work environment
• Apply your inpatient nursing expertise in a non-bedside role
• Collaborate with hospitals, providers, and interdisciplinary care teams
• Enhance your Utilization Management and Concurrent Review experience
• Make a meaningful impact on quality care, resource utilization, and patient outcomes

Work from Home Requirements

You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted. A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours. Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live. The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time). If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves.

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.

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility

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

Application window will close on: 10/17/2026

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

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.

Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.