UM Nurse Consultant - Concurrent Review

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

About This Role

The Utilization Management Nurse Consultant (RN) – Concurrent Review position is ideal for experienced RNs with a background in acute care and utilization management. This role focuses on ensuring members receive appropriate, high-quality, and cost-effective inpatient care through concurrent review and care coordination.

Highlights

• Pay: $26 - $56/hour
• Location: Remote, LA
• Schedule: Full-time

What You'll Do

• 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.

Requirements

• Education:
• Associate Degree in Nursing (ASN) required
• Bachelor of Science in Nursing (BSN) preferred
• Experience:
• 5+ years of acute care nursing experience
• 2+ years of Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review experience
• Licenses & Certifications:
• Active, unrestricted RN license in your state of residence
• Ability to obtain and maintain additional state licensure as required

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on building a world of health around every individual, shaping a more connected, convenient, and compassionate health experience.