NICU Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 0 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Support high-risk neonatal populations through clinical review, care coordination, and evidence-based decision-making • Collaborate with neonatologists, hospitals, case managers, and interdisciplinary teams • Evaluate medical necessity • Determine appropriate levels of care • Facilitate timely, cost-effective services for newborns and infants requiring specialized care • Support quality outcomes and discharge planning • Facilitate seamless transitions of care • Ensure 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 • Minimum 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 the computer • Minimum internet speed of 25 Mbps download and 3 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines • Ability to work within the state and city where currently living • Ability to provide own workspace furniture • Ability to use multiple monitors and navigate multiple applications simultaneously • Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace tools • Ability to log in to secure systems such as VPN and EHR portals • Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to troubleshoot common technical issues independently • Openness to learning new skills as the workplace evolves

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • 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.)