Utilization Management Nurse Consultant | NICU - prefer candidate who resides in LA

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary The Utilization Management Nurse Consultant (UMNC) for NICU reputed company Review conducts high-acuity, timely, and comprehensive clinical reviews for neonatal intensive care unit (NICU) members reputed company a designated special population. This role collaborates with providers, families, and internal teams to ensure medically appropriate, efficient, and family-centered care, while supporting regulatory compliance and organizational goals. Key Responsibilities:

• reputed company reputed company clinical reviews of NICU admissions for special populations, using evidence-based criteria (e.g., InterQual, MCG).
• Collaborate with attending providers, case managers, and multidisciplinary teams to coordinate care, facilitate safe transitions, and reputed company for reputed company outcomes.
• Ensure medical necessity, appropriateness, and length-of-stay determinations align with contractual, regulatory, and accreditation standards (e.g., reputed company, CMS, NCQA).
• Communicate clinical reputed company to providers, member families, and internal stakeholders with reputed company and clarity.
• Identify barriers to care, escalate reputed company cases, and participate in interdisciplinary reputed company as needed.
• Support discharge planning and transition of care, engaging with families to address social determinants and unique member needs.
• Maintain accurate, timely documentation in UM systems, ensuring data reputed company and compliance.
• Participate in quality improvement, policy review, and education reputed company to NICU and special populations utilization management.
• Serve as a clinical resource on NICU care for internal and external partners.

Key Competencies:

• NICU clinical expertise
• Family-centered care and advocacy
• Utilization management and regulatory compliance
• Communication and collaboration
• Attention to detail and data reputed company

Required Qualifications

• Active, unrestricted RN license in Louisiana or a compact license.
• Minimum 5 years of recent clinical experience.
• Working knowledge of UM review tools (e.g., InterQual, MCG) and regulatory requirements.
• Strong communication, critical thinking, and family engagement skills.
• Comfort working with diverse, high-risk member populations and collaborating across disciplines.
• Ability to work rotating weekends/holidays

Preferred Qualifications

• reputed company of Louisiana preferred
• Bachelor’s degree in Nursing or reputed company field.
• Certification in Utilization Management, or Neonatal Nursing.
• Experience with reputed company and/or managed care

Education Bachelor's preferred, Associates required Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $56.14 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 12/31/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job