Remote Utilization Management Nurse Consultant

CVS Health Corporation; Phoenix (AZ); Remote; USD 61,000 - 130,000; Full time

Benefits offered by this job

Medical insurance

Dental & vision coverage

Paid time off

Retirement savings

Job summary

CVS Health Corporation is seeking a Nurse Consultant to join our Utilization Management team. The role focuses on applying clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorizing care, and escalating cases when needed.

The position requires an active RN license, 3+ years in behavioral health or substance abuse nursing, and 1+ year in concurrent review. A mandatory 3-week training with full participation is included.

Qualifications

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

Responsibilities

• Review inpatient and outpatient services using evidence-based criteria.
• Collaborate with providers to authorize care and elevate cases as needed.
• Navigate multiple systems and maintain accurate documentation in a fast-paced environment.
• Support on-call rotational coverage on weekends/holidays as required by URAC and Client requirements.

Job description

CVS Health Corporation is seeking a Nurse Consultant to join our Utilization Management team. The role focuses on applying clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorizing care, and escalating cases when needed.

The position requires an active RN license, 3+ years in behavioral health or substance abuse nursing, and 1+ year in concurrent review. A mandatory 3-week training with full participation is included.