UM Nurse Consultant

CVS Health•Work At Home-Louisiana, LA

7d•$26 - $56•Remote

About The Position

CVS Health is hiring a remote Concurrent Review Nurse (RN) to apply inpatient clinical expertise to utilization management. The role evaluates inpatient admissions and continued stays to help ensure members receive appropriate, high-quality, and cost-effective healthcare services. The nurse collaborates with hospitals, physicians, utilization review departments, care teams, and internal stakeholders on levels of care, discharge planning, and care transitions. The schedule is Monday through Friday, 8:00 AM–5:00 PM CST, with occasional rotating weekend coverage and rotating holiday on-call responsibilities. The role is fully remote, subject to work-from-home requirements. Colleagues must work from the state and city where they have confirmed they live, maintain a quiet and secure designated workspace, and have a direct wired internet connection meeting specified speed requirements. CVS Health provides computer equipment; the colleague supplies workspace furniture. This is a full-time position with 40 anticipated weekly hours. The stated pay range is $26.01–$56.14 per hour. The position is eligible for a CVS Health bonus, commission, or short-term incentive program, as well as a comprehensive benefits package based on eligibility.

Requirements

Active, unrestricted RN license with Louisiana licensure or Compact RN licensure.
Ability and willingness to obtain additional state licensure as required.
At least 5 years of inpatient clinical nursing experience.
Strong clinical assessment, critical-thinking, and communication skills.
Associate degree required.
Ability to participate in rotating weekend coverage and holiday on-call schedules.
Meet work-from-home requirements, including a direct/hardwired internet connection with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
Maintain a quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines, and work from the state and city where residence has been confirmed.
Provide workspace furniture and be able to work at a desk for extended periods.
Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.
Experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
Ability to access secure systems, follow computer and password security practices, recognize suspicious emails or links, and troubleshoot common technical issues.

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.
Bachelor’s degree preferred.
Openness to learning new skills as the workplace environment evolves.

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.
Participate in rotating weekend coverage and holiday on-call schedules.