[Hiring] Concurrent Review Nurse @CVS Health

Role Description

Are you an experienced inpatient Registered Nurse looking to transition into a remote role where you can use your clinical expertise to influence patient care across the continuum? Join our Concurrent Review team and help ensure members receive appropriate, high-quality, and cost-effective healthcare services.

• Conduct concurrent reviews for inpatient admissions and continued stays
• Evaluate clinical documentation and determine medical necessity using established guidelines and evidence-based criteria
• Collaborate with hospitals, physicians, utilization review departments, and care teams to support appropriate levels of care
• Facilitate timely discharge planning and care transitions
• Monitor ongoing inpatient treatment and identify opportunities to improve healthcare utilization and outcomes
• Communicate recommendations and clinical findings to providers and internal stakeholders
• Support effective resource utilization while maintaining quality and compliance standards

Qualifications

• Active, unrestricted RN license with Louisiana licensure or Compact RN licensure
• Ability and willingness to obtain additional state licensure as required
• 5+ years of inpatient clinical nursing experience
• Strong clinical assessment, critical-thinking, and communication skills
• Ability to participate in rotating weekend coverage and holiday on-call schedules

Requirements

• Utilization Management or Concurrent Review experience (preferred)
• Experience using MCG (Milliman Care Guidelines) and/or InterQual (preferred)
• Acute inpatient discharge planning experience (preferred)
• Managed Care experience (preferred)

Benefits

• Fully remote work environment
• Apply your inpatient nursing expertise in a non-bedside role
• Collaborate with hospitals, providers, and interdisciplinary care teams
• Enhance your Utilization Management and Concurrent Review experience
• Make a meaningful impact on quality care, resource utilization, and patient outcomes

Work from Home Requirements

• Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $26.01 - $56.14. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Company Description

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

• Great benefits for great people
• Comprehensive and competitive mix of pay and benefits
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility