Remote Behavioral Health Utilization Nurse Consultant

CVS Health Corporation; Northern (KY); Hybrid; USD 60,000 - 130,000; Full time

Benefits offered by this job

Medical benefits

Dental and vision coverage

Paid time off

Job summary

CVS Health Corporation is seeking a Utilization Management Nurse Consultant to review inpatient and outpatient services remotely. You will apply evidence-based criteria, collaborate with providers, and authorize care while maintaining documentation.

A mandatory training program and on-call rotation are part of the role, with strong emphasis on accuracy and efficiency. The ideal candidate holds an RN license, 1+ year BH/SA review experience, and 3+ years of relevant clinical background.

Qualifications

• Active unrestricted state Registered Nurse licensure in state of residence is required.
• 1+ year: Behavioral Health and Substance Abuse concurrent review or prior authorization experience.
• 3+ years of acute behavioral health and/or substance abuse clinical experience.
• Commitment to attend a mandatory 3-week training (Mon–Fri, 8:30am–5:00pm EST) with 100% participation.

Responsibilities

• Apply clinical judgment and evidence-based criteria to review inpatient and outpatient services.
• Collaborate with providers, authorize care, and escalate cases when needed.
• Navigate multiple systems and maintain accurate documentation.
• Ability to work occasional on-call rotational coverage on weekends and holidays.

Skills

Critical thinking

Clinical judgment

Education

Associate's degree in nursing

BSN preferred

Job description

CVS Health Corporation is seeking a Utilization Management Nurse Consultant to review inpatient and outpatient services remotely. You will apply evidence-based criteria, collaborate with providers, and authorize care while maintaining documentation.

A mandatory training program and on-call rotation are part of the role, with strong emphasis on accuracy and efficiency. The ideal candidate holds an RN license, 1+ year BH/SA review experience, and 3+ years of relevant clinical background.