UM Nurse Consultant – Concurrent Review

Job not on LinkedIn

🔥 20 hours ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.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

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

• 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 quality outcomes and appropriate healthcare utilization • Coordinate with physicians, hospitals, and interdisciplinary care teams • 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 • 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 • 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 residing • Ability to provide workspace furniture, such as a desk or standing desk • Comfortable setting up and using multiple monitors and navigating 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 manage strong passwords and recognize suspicious emails or links • Ability to resolve common technical issues independently • Openness to learning new skills as the workplace evolves • BSN preferred • Louisiana residency preferred • Experience supporting Louisiana Medicaid populations preferred

🏖️ 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 • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Remote work arrangement • Other resources supporting physical, emotional, and financial well-being