Specialty UM - NICU UM Nurse Consultant - Louisiana Residence Preferred

CVS Health•Work At Home-Louisiana, LA

3d•$26 - $56•Remote

About The Position

We are seeking an experienced NICU Utilization Management Nurse Consultant to support high-risk neonatal populations through clinical review, care coordination, and evidence-based decision-making. In this role, you will collaborate with neonatologists, hospitals, case managers, and interdisciplinary teams to evaluate medical necessity, determine appropriate levels of care, and facilitate timely, cost-effective services for newborns and infants requiring specialized care. You'll play a critical role in supporting quality outcomes, discharge planning, and seamless transitions of care while ensuring compliance with regulatory and accreditation standards.

Requirements

Active, unrestricted RN license in the state of residence. Ability to obtain and maintain additional state licensure as required by business needs.
3+ years of clinical NICU nursing experience minimum
1+ years of experience in utilization management, case management, managed care, NICU, pediatrics, or maternal-child health
Strong knowledge of neonatal intensive care, prematurity, congenital conditions, and complex infant care needs
Experience reviewing medical records and applying evidence-based clinical criteria (MCG or similar tools)
Excellent clinical judgment, communication, and collaboration skills
Proficiency with electronic medical records and utilization management systems
Associates Degree in Nursing
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.
Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
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.
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.
Openness to learning new skills in the future as the workplace environment evolves.

Nice To Haves

BSN
NICU, pediatric inpatient, maternal-child health, or neonatal case management experience
Health plan utilization management experience (Medicaid, Medicare, or Commercial)
Experience supporting Louisiana Medicaid populations
Louisiana residency preferred

Responsibilities

Collaborate with neonatologists, hospitals, case managers, and interdisciplinary teams to evaluate medical necessity.
Determine appropriate levels of care for newborns and infants requiring specialized care.
Facilitate timely, cost-effective services for newborns and infants requiring specialized care.
Support quality outcomes for high-risk neonatal populations.
Assist with discharge planning for neonatal patients.
Ensure seamless transitions of care for infants.
Ensure compliance with regulatory and accreditation standards.