UM Nurse Consultant – Concurrent Review

Job not on LinkedIn

🕒 6 days ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 12%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• 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 • Support members through critical transitions of care and discharge planning

🎯 Requirements

• Active, unrestricted RN license in your state of residence • Ability to obtain and maintain additional state licensure as required • 5+ years of acute care nursing experience • 2+ years of Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review experience • Experience reviewing acute inpatient admissions and continued stay requests • Experience applying MCG or similar evidence-based clinical criteria • Knowledge of inpatient hospital operations, discharge planning, and transitions of care • Strong clinical assessment, critical thinking, and decision-making skills • Excellent written and verbal communication skills • Proficiency with electronic medical records and utilization management systems • Associate Degree in Nursing (ASN) required • Must have or be able to obtain a direct/hardwired internet connection with minimum 25 Mbps download and 3 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Experience with multiple monitors and simultaneous application navigation • Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer security practices, manage strong passwords, and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Remote work arrangement • CVS Health bonus, commission or short-term incentive program in addition to base pay

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