Remote Utilization Management Nurse Consultant - Behavioral Health

CVS Health; Nashville (TN); Remote; USD 40,000 - 86,000; Full time

Job summary

CVS Health is seeking a Nurse Consultant to join our Utilization Management team. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers, authorize care, and elevate cases when needed.

This role suits nurses who thrive in fast-paced environments and are comfortable with computer-based work. Remote work is 100% remote with a dedicated workspace; a mandatory 3-week training is required.

Qualifications

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

Responsibilities

• Review inpatient and outpatient services using clinical criteria for precertification.
• Collaborate with providers to authorize care and escalate cases when needed.
• Navigate multiple systems and maintain accurate documentation.
• Support on-call rotational coverage on weekends/holidays as required.

Skills

RN licensure

Behavioral health

Prior authorization

Clinical review

Remote work

Education

Associate's degree in Nursing

BSN preferred

Job description

CVS Health is seeking a Nurse Consultant to join our Utilization Management team. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers, authorize care, and elevate cases when needed.

This role suits nurses who thrive in fast-paced environments and are comfortable with computer-based work. Remote work is 100% remote with a dedicated workspace; a mandatory 3-week training is required.