Utilization Management Nurse Consultant – Prior Authorization
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Louisiana • United States
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Salary
💰 $26 - $56 per hour
About the role
- Conducts high-acuity, timely, and comprehensive clinical reviews for members
- Collaborate with providers and internal teams to ensure medically appropriate, efficient, and family-centered care
- Perform prior authorization clinical reviews of acute admissions using evidence-based criteria
- Ensure medical necessity, appropriateness, and length-of-stay determinations align with standards
- Communicate clinical decisions to providers, member families, and internal stakeholders
- Identify barriers to care, escalate complex cases, and participate in interdisciplinary rounds
- Maintain accurate, timely documentation in UM systems
- Participate in quality improvement, policy review, and education related to utilization management
Requirements
- Active, unrestricted Louisiana RN license or compact license
- Minimum 3 years of recent clinical experience
- Ability to work 8-5 CST and rotating weekend/holiday coverage
- Strong communication, critical thinking, and family engagement skills
- Comfort working with diverse, high-risk member populations and collaborating across disciplines
- Bachelor's degree preferred/specialized training/relevant professional qualification
- 3-5 years of relevant work experience
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings
- Tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical reviewsprior authorizationevidence-based criteriamedical necessity determinationlength-of-stay determinationdocumentation in UM systemsquality improvementpolicy revieweducation related to utilization management
Soft Skills
communication skillscritical thinkingfamily engagement skillscollaborationproblem-solvinginterdisciplinary teamwork
Certifications
Louisiana RN licensecompact license