Remote Utilization Management Nurse Consultant

4062 Aetna Resources, LLC; Arizona; Hybrid; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Retirement savings

Job summary

CVS Health is seeking a Nurse Consultant in Utilisation Management for a 100% remote role in the United States. You will review inpatient and outpatient services, authorise care, and coordinate with providers, while maintaining documentation and supporting URAC guidelines.

The position requires an active RN license, 3+ years of behavioural health experience, and availability for on-call rotations. Training is a 3-week program with full participation.

Qualifications

• Active RN licensure in state of residence.
• 3+ years acute behavioural health experience.
• 1+ year concurrent review or prior authorisation.
• Must attend mandatory 3-week training (Mon-Fri 8:30am-5:00pm EST).

Responsibilities

• Apply criteria to review inpatient/outpatient services for precertification.
• Collaborate with providers, authorise care, escalate cases as needed.
• Navigate multiple systems and maintain accurate documentation.
• Occasional on-call coverage on weekends/holidays may be required.

Skills

RN licensure

Behavioural health

Acute care

Prior authorization

On-call readiness

Education

Associate degree in nursing

Job description

CVS Health is seeking a Nurse Consultant in Utilisation Management for a 100% remote role in the United States. You will review inpatient and outpatient services, authorise care, and coordinate with providers, while maintaining documentation and supporting URAC guidelines.

The position requires an active RN license, 3+ years of behavioural health experience, and availability for on-call rotations. Training is a 3-week program with full participation.