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

• Ensure medical necessity, appropriateness, and length-of-stay determinations align with contractual, regulatory, and accreditation standards (e.g., Medicaid, CMS, NCQA).
• Communicate clinical decisions to providers, member families, and internal stakeholders with empathy and clarity.
• Identify barriers to care, escalate complex cases, and participate in interdisciplinary rounds 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 integrity and compliance.
• Participate in quality improvement, policy review, and education related 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 integrityRequired 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/holidaysPreferred Qualifications
• Resident of Louisiana preferred

• Bachelor's degree in Nursing or related field.
• Certification in Utilization Management, or Neonatal Nursing.
• Experience with Medicaid and/or managed care

Education
Bachelor's preferred, Associates required Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$26.01 - $56.14This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base 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 peopleWe 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 all 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/benefitsWe anticipate the application window for this opening will close on: 12/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Client-provided location(s): Baton Rouge, LA

Job ID: CVS-R0794795

Employment Type: OTHER

Posted: 2025-12-19T19:43:41