Remote Utilization Nurse Consultant

CVS Health Corporation; United States; Remote; USD 40,000 - 86,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Remote work

Job summary

CVS Health Corporation is seeking a Nurse Consultant for the Utilization Management team. This 100% remote full-time role involves applying clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorizing care, and coordinating with providers while maintaining accurate documentation.

The position requires RN licensure, 3+ years in behavioral health or substance abuse nursing, and 1+ year in concurrent review or prior authorization.

Qualifications

• Active unrestricted state RN licensure in state of residence.
• 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

• Review inpatient and outpatient services using evidence-based criteria for precertification.
• Authorize care and escalate cases as needed in collaboration with providers.
• Navigate multiple systems and document thoroughly in electronic records.
• Work occasional on-call rotation for weekends and holidays per URAC and client requirements.

Job description

CVS Health Corporation is seeking a Nurse Consultant for the Utilization Management team. This 100% remote full-time role involves applying clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorizing care, and coordinating with providers while maintaining accurate documentation.

The position requires RN licensure, 3+ years in behavioral health or substance abuse nursing, and 1+ year in concurrent review or prior authorization.