Remote Utilization Management Nurse Consultant

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

401(k) retirement

Job summary

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote capacity. The role reviews inpatient and outpatient services using evidence-based criteria, authorizes care with providers, and escalates cases as needed.

Training is mandatory for all new hires, with a structured Monday–Friday schedule and on-call elements. The position requires an active RN license and 3+ years in acute behavioral health/substance abuse, plus experience with concurrent review or prior

Qualifications

• Active unrestricted state RN 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 (Monday-Friday, 8:30am-5:00pm EST) with 100% participation.

Responsibilities

• Apply clinical judgment and evidence-based criteria to review inpatient and outpatient services.
• Collaborate with providers, authorize care, and elevate cases when needed.
• Navigate multiple systems and maintain accurate documentation.
• Work the occasional on-call rotational coverage on weekends and some holiday coverage (URAC and Client Requirements).

Skills

RN licensure

behavioral health

prior authorization

clinical nursing

Education

Associate's degree in nursing

BSN preferred

Job description

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote capacity. The role reviews inpatient and outpatient services using evidence-based criteria, authorizes care with providers, and escalates cases as needed.

Training is mandatory for all new hires, with a structured Monday–Friday schedule and on-call elements. The position requires an active RN license and 3+ years in acute behavioral health/substance abuse, plus experience with concurrent review or prior