NICU Utilization Management Nurse Consultant - Louisiana Residence Preferred

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. NICU Utilization Management Nurse Consultant (Remote) Are you passionate about improving outcomes for the most vulnerable patients? We are seeking an experienced NICU Utilization Management Nurse Consultant to support high-risk neonatal populations through clinical review, care coordination, and evidence-based decision-making. In this role, you will collaborate with neonatologists, hospitals, case managers, and interdisciplinary teams to evaluate medical necessity, determine appropriate levels of care, and facilitate timely, cost-effective services for newborns and infants requiring specialized care. You'll play a critical role in supporting quality outcomes, discharge planning, and seamless transitions of care while ensuring compliance with regulatory and accreditation standards. What You'll Bring - REQUIRED Active, unrestricted RN license in the state of residence.  Ability to obtain and maintain additional state licensure as required by business needs. 3+ years of clinical NICU nursing experience minimum 1+ years of experience in utilization management, case management, managed care, NICU, pediatrics, or maternal-child health Strong knowledge of neonatal intensive care, prematurity, congenital conditions, and complex infant care needs Experience reviewing medical records and applying evidence-based clinical criteria (MCG or similar tools) Excellent clinical judgment, communication, and collaboration skills Proficiency with electronic medical records and utilization management systems Associates Degree in Nursing Preferred Qualifications BSN NICU, pediatric inpatient, maternal-child health, or neonatal case management experience Health plan utilization management experience (Medicaid, Medicare, or Commercial) Experience supporting Louisiana Medicaid populations Louisiana residency preferred Why Join Us? Meaningful work that directly impacts neonatal and infant health outcomes Collaborative, mission-driven environment Opportunity to leverage your NICU expertise in a remote setting Focus on quality, innovation, and member-centered care If you're a skilled RN with a passion for neonatal care and utilization management, we'd love to hear from you. Apply today to help ensure the right care is delivered at the right time for our smallest patients. Work from Home Requirements: You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted. A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours. Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live. The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time). If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements. Technical and Logistical Requirements: Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency. Communication Tools: Ability to communicate on digital channels such as via