Remote Utilization Management Nurse Consultant

Preferra Insurance; Phoenix (AZ); Remote; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers to authorize care, and elevate cases when needed while maintaining thorough documentation.

The position requires active RN licensure, 3+ years of acute behavioral health or substance abuse nursing, and 1+ year in concurrent review or prior authorization, with a mandatory

Qualifications

• Active unrestricted RN licensure in resident state is required.
• Minimum 3 years of acute behavioral health and/or substance abuse clinical nursing experience.
• At least 1 year of concurrent review or prior authorization preferably in Behavioral Health and Substance Abuse.
• 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, authorize care, escalate cases when needed.
• Navigate multiple systems and maintain accurate documentation.
• Occasional on-call rotational coverage on weekends and holidays as required.

Skills

RN licensure

Clinical nursing

Behavioral health

Education

ADN/Associate RN degree

BSN preferred

Job description

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers to authorize care, and elevate cases when needed while maintaining thorough documentation.

The position requires active RN licensure, 3+ years of acute behavioral health or substance abuse nursing, and 1+ year in concurrent review or prior authorization, with a mandatory