UM Nurse Consultant – Post Acute Specialty

Job not on LinkedIn

🔥 17 hours 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

• Perform utilization management reviews and authorization activities for post-acute services • Evaluate medical necessity and appropriateness of services using clinical criteria, applicable policies, and regulatory requirements • Review services for SNF, IRF, LTACH, Home Health, and other post-acute levels of care • Collaborate with providers, care managers, medical directors, and interdisciplinary teams • Facilitate timely care transitions and ensure member needs are met • Support quality, cost-effective care and organizational goals • Exercise independent clinical judgment and manage multiple priorities in a fast-paced environment

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license in the state of residence • Ability to obtain and maintain additional state licensure as required by business needs • 3+ years of clinical nursing experience • 1+ years of utilization management, case management, discharge planning, managed care, or post-acute care experience • Experience reviewing medical records and applying evidence-based clinical criteria to determine medical necessity • Knowledge of post-acute levels of care, including SNF, IRF, LTACH, and Home Health services • Experience using MCG or similar clinical decision support tools • Strong clinical assessment and critical thinking skills • Effective written and verbal communication skills • Proficiency with electronic medical records and utilization management platforms • Associate Degree in Nursing (ASN) required

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program eligibility