Remote Utilization Management Nurse Consultant

CVS Health Corporation; Arizona; Hybrid; USD 40,000 - 85,000; Full time

Job summary

CVS Health Corporation is seeking a Nurse Consultant to join our Utilization Management team. This remote role reviews inpatient and outpatient services using clinical judgment and evidence-based criteria, collaborates with providers, authorizes care, and elevates cases as needed.

It suits nurses who are organized, decisive and comfortable with computer-based work. The position requires an active RN license, 1+ year in behavioral health and prior authorization, 3+ years in acute behavioral

Qualifications

• Active unrestricted state RN licensure in state of residence 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 (Monday–Friday, 8:30am–5:00pm EST) with 100% participation.

Responsibilities

• MUST have the ability to work the occasional on-call rotational coverage on weekends and some rotational on-call holiday coverage (URAC and Client Requirements).
• Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for treatment and services both inpatient and outpatient services requiring precertification.
• Utilization Management nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.
• Position requires proficiency with computer skills which includes navigating multiple systems.

Skills

RN licensure

Clinical experience

Remote work

Education

Associate's degree in nursing

BSN preferred

Job description

CVS Health Corporation is seeking a Nurse Consultant to join our Utilization Management team. This remote role reviews inpatient and outpatient services using clinical judgment and evidence-based criteria, collaborates with providers, authorizes care, and elevates cases as needed.

It suits nurses who are organized, decisive and comfortable with computer-based work. The position requires an active RN license, 1+ year in behavioral health and prior authorization, 3+ years in acute behavioral