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
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 email, calendar invites, Teams messaging, and virtual meetings.
- Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
- Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
- Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
- Future Growth: Openness to learning new skills in the future as the workplace environment evolves
Anticipated Weekly Hours: 40
Time Type: Full time
Pay Range
The typical pay range for this role is
$26.01 - $56.14