Nurse Consultant

CVS Health

. Review clinical information and apply medical necessity criteria and clinical judgment to coverage recommendations .

Posted 10/6/2026full-timeRemote • Louisiana • United StatesMid-LevelSenior💰 $26 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management, Concurrent Review, and Discharge Planning, with a strong foundation in inpatient clinical nursing. Proficient in Microsoft 365 and capable of managing remote work environments while ensuring compliance with healthcare regulations.

Highest-signal resume keywords

Active RN License5+ Years Inpatient Clinical Nursing ExperienceUtilization Management ExperienceKnowledge of MCG and/or InterQualMicrosoft 365 Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ManagementConcurrent ReviewCase ManagementDischarge PlanningClinical ReviewInpatient NursingHealthcare UtilizationCare Management ReferralsMedical Necessity CriteriaClinical Judgment

Soft Skills

CollaborationCommunicationProblem-SolvingAdaptabilityIndependence

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNEHR PortalsTeams Messaging

Certifications & Qualifications

Active RN LicenseAssociate’s Degree in NursingBSN Preferred

Industry Keywords

Managed CareHealthcare ComplianceHIPAA GuidelinesRemote WorkCare Coordination

About the role

Key responsibilities & impact

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
Perform RN concurrent review remotely from home

Requirements

What you’ll need

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
Managed care/utilization review and discharge planning experience preferred
Knowledge of MCG and/or InterQual preferred
Microsoft 365 proficiency
Willingness to work Monday–Friday, 8:00 AM–5:00 PM CST
Occasional weekend coverage and rotating holiday coverage
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 25 Mbps download and 3 Mbps upload
Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently living
Must provide workspace furniture
Ability to set up and use multiple monitors and navigate multiple applications
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace applications
Ability to log in to secure systems, use VPN/EHR portals, lock screens, manage strong passwords, and recognize suspicious emails or links
Ability to resolve common technical issues independently
Openness to learning new skills as the workplace evolves

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
Remote work from home
Company-provided equipment (keyboard, monitor, computer, headset, etc.)