UM Nurse Consultant - Concurrent Review

About This Role

The Utilization Management Nurse Consultant (RN) – Concurrent Review position is ideal for experienced RNs with a background in acute care and utilization management. This role focuses on ensuring members receive appropriate, high-quality, and cost-effective inpatient care through concurrent review and care coordination.

Highlights

• Pay: $26 - $56/hour
• Location: Remote, LA
• Schedule: Full-time

What You'll Do

• 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.

Requirements

• Education:
• Associate Degree in Nursing (ASN) required
• Bachelor of Science in Nursing (BSN) preferred
• Experience:
• 5+ years of acute care nursing experience
• 2+ years of Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review experience
• Licenses & Certifications:
• Active, unrestricted RN license in your state of residence
• Ability to obtain and maintain additional state licensure as required

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on building a world of health around every individual, shaping a more connected, convenient, and compassionate health experience.