Nurse Consultant

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Evaluate clinical data and utilize medical necessity standards and clinical insight to inform coverage decisions.

• Partner with healthcare providers and internal teams to ensure effective care coordination and discharge planning.

• Recognize opportunities for care management referrals and enhanced healthcare utilization.

• Facilitate timely and efficient care for members throughout the healthcare continuum.

• Conduct RN concurrent reviews remotely from a home setting.

⛳️ Requirements

• Must possess an active, unrestricted RN license from Louisiana or a Compact RN license.

• Willingness to acquire additional state licenses as required.

• A minimum of 5 years of experience in inpatient clinical nursing.

• At least 2 years of experience in Utilization Management, Concurrent Review, Case Management, Discharge Planning, Managed Care, or Clinical Review.

• An Associate’s degree in nursing is mandatory.

• A Bachelor of Science in Nursing (BSN) is preferred.

• Preferred experience in managed care/utilization review and discharge planning.

• Familiarity with MCG and/or InterQual preferred.

• Proficiency in Microsoft 365 is required.

• Availability to work Monday through Friday from 8:00 AM to 5:00 PM CST.

• Willingness to provide occasional weekend and rotating holiday coverage.

• A direct/hardwired internet connection to a modem/router within 7 feet of the computer is necessary.

• Minimum internet speed of 25 Mbps download and 3 Mbps upload is required.

• A quiet, secure, and private designated workspace that complies with CVS Health and HIPAA standards is essential.

• Must reside and work within the state and city of current residence.

• Workspace furniture must be provided by the candidate.

• Capability to set up and utilize multiple monitors and navigate various applications.

• Proficient in using email, calendar invites, Teams messaging, and virtual meetings.

• Experience with Microsoft Office 365 applications or similar Google Workspace applications is beneficial.

• Ability to log into secure systems, use VPN/EHR portals, manage strong passwords, and identify suspicious emails or links.

• Competence in independently resolving common technical issues.

• Willingness to learn new skills as workplace demands evolve.

🏝️ Benefits

• Participation in CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Comprehensive medical coverage.

• Dental coverage options.

• Vision coverage available.

• Generous paid time off.

• Retirement savings plans.

• Access to wellness programs.

• Additional resources promoting physical, emotional, and financial well-being.

• Opportunity for remote work from home.

• Company-supplied equipment (keyboard, monitor, computer, headset, etc.) provided.