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.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This 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 people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.