Remote Utilization Management Nurse Consultant

Voices for Voices; Phoenix (AZ); Remote; USD 40,000 - 86,000; Full time

Job summary

CVS Health is seeking a Nurse Consultant for a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorize care, and escalate cases as needed, while coordinating with providers and internal teams.

The role requires an active RN license, 3+ years in acute behavioral health/substance abuse, and completion of a mandatory 3-week training with full participation. This position is remote with statewide responsibilities.

Qualifications

• Active unrestricted RN licensure in state of residence.
• 3+ years of acute behavioral health and/or substance abuse nursing experience.
• 1+ year of concurrent review or prior authorization in Behavioral Health/Substance Abuse.
• Commitment to attend a mandatory 3-week training with 100% participation.

Responsibilities

• MUST be able to work occasional on-call coverage on weekends and some holidays.
• Apply evidence-based criteria for inpatient/outpatient services requiring precertification.
• Authorize procedures/services or initiate Medical Director referrals as needed.
• Navigate multiple systems and document clinical information during computer-based work.

Skills

RN licensure

Behavioral health nursing

Clinical nursing

On-call coverage

Education

Associate's degree in nursing

BSN preferred

Job description

CVS Health is seeking a Nurse Consultant for a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorize care, and escalate cases as needed, while coordinating with providers and internal teams.

The role requires an active RN license, 3+ years in acute behavioral health/substance abuse, and completion of a mandatory 3-week training with full participation. This position is remote with statewide responsibilities.