CVS Health

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Utilization Management Nurse Consultant – Prior Authorization

ConsultantConsultantFull TimeRemoteTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Louisiana

Posted

9 days ago

Salary

$26 - $56 / hour

Associate Degree3 yrs expEnglish

Job Description

• 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

Job 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

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