Concurrent Review UM Nurse Consultant - Louisiana Residence

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.

• Pay: $26.01 - $56.14/hour
• Location: Remote, LA
• Residency: Louisiana residency preferred
• Schedule: Full-time

• Review authorization requests across a broad range of medical specialties.
• Evaluate medical necessity using clinical records, evidence-based guidelines, and benefit plan requirements.
• Apply Inter Qual, 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.

• Associate Degree in Nursing (ASN) required
• Bachelor of Science in Nursing (BSN) preferred

• 3+ years of clinical nursing experience
• 2+ years of Utilization Management, Prior Authorization, Managed Care, Case Management, or Clinical Review experience

• 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

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

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.