Concurrent Review UM Nurse Consultant - Louisiana Residence Preferred

About This Role The Concurrent Review UM Nurse Consultant role at CVS Health is ideal for experienced RNs with a background in utilization management or prior authorization. This position focuses on ensuring members receive timely and appropriate healthcare services through evidence-based clinical review. Highlights Pay: $26.01 - $56.14/hour Location: Remote, LA Residency: Louisiana residency preferred Schedule: Full-time What You'll Do Review authorization requests across a broad range of medical specialties. Evaluate medical necessity using clinical records, evidence-based guidelines, and benefit plan requirements. Apply InterQual, MCG, or similar clinical criteria to support authorization determinations. Collaborate with providers, care managers, medical directors, and interdisciplinary teams to facilitate quality care. Ensure compliance with health plan policies, regulatory requirements, and clinical standards. Manage a high-volume caseload while meeting productivity, quality, and turnaround-time expectations. Support effective healthcare utilization and positive member outcomes. Requirements Education: Associate Degree in Nursing (ASN) required Bachelor of Science in Nursing (BSN) preferred Experience: 3+ years of clinical nursing experience 2+ years of Utilization Management, Prior Authorization, Managed Care, Case Management, or Clinical Review experience Licenses & Certifications: Active, unrestricted multi-state RN license in your state of residence, or the ability to obtain and maintain multi-state Ability to obtain and maintain additional state licensure as needed 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, ensuring a connected and compassionate health experience for all. #J-18808-Ljbffr CVS Health Corporation