UM Nurse Consultant
About The Position
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. Concurrent Review Nurse (RN) 100% Remote | Monday–Friday, 8:00 AM–5:00 PM CST Occasional Weekend & Holiday On-Call Coverage 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.
Requirements
- 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
- 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.
- 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.
- 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.
Nice To Haves
- Utilization Management or Concurrent Review experience
- Experience using MCG (Milliman Care Guidelines) and/or InterQual
- Acute inpatient discharge planning experience
- Managed Care experience
Responsibilities
- 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
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
