Remote Utilization Management Nurse Consultant

CVS Health; United States; Remote; USD 40,000 - 85,000; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

CVS Health is seeking a Nurse Consultant for Utilization Management to review inpatient and outpatient services, apply criteria, authorize care, and escalate cases as needed. This 100% remote role requires strong clinical judgment and organization for fast-paced environments.

Applicants must hold an RN license, have 1+ year behavioral health and 3+ years acute behavioral health experience, and complete a mandatory three-week training with full participation.

Qualifications

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

Responsibilities

• Review inpatient and outpatient services using evidence-based criteria.
• Collaborate with providers, authorize care, and escalate cases as needed.
• Navigate multiple systems and maintain accurate documentation.
• Support a fast-paced, highly organized clinical environment.

Skills

RN licensure

Behavioral health

Clinical experience

On-call flexibility

Education

Associate’s degree in nursing (RN)

BSN preferred

Job description

CVS Health is seeking a Nurse Consultant for Utilization Management to review inpatient and outpatient services, apply criteria, authorize care, and escalate cases as needed. This 100% remote role requires strong clinical judgment and organization for fast-paced environments.

Applicants must hold an RN license, have 1+ year behavioral health and 3+ years acute behavioral health experience, and complete a mandatory three-week training with full participation.