[Hiring] UM Nurse Consultant @CVS Health

Role Description

Join our team as an RN Concurrent Review Nurse, where you’ll use your inpatient clinical expertise to help ensure members receive appropriate, medically necessary care throughout the continuum of care.

Schedule & Location:

• Work from home
• Monday–Friday, 8:00 AM–5:00 PM CST
• Occasional weekend coverage and rotating holiday coverage

What You’ll Do:

• Review clinical information and apply medical necessity criteria and clinical judgment to coverage recommendations
• Collaborate with providers and internal teams to coordinate appropriate care and discharge planning
• Identify opportunities for care management referrals and improved healthcare utilization
• Support timely, effective care for members across the continuum

Qualifications

• Active, unrestricted Louisiana or Compact RN license required
• Must be willing to obtain additional state licenses as needed
• 5+ years of inpatient clinical nursing experience
• 2+ years of Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review experience
• Associate’s degree in nursing required; BSN preferred

Requirements

• Managed care/utilization review and discharge planning experience preferred
• Knowledge of MCG and/or InterQual preferred
• Microsoft 365 proficiency

Work from Home Requirements

• You 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.

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.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility