Senior RN – Prior Authorization & Care Utilization

CVS Health Corporation; Northern (KY); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement benefits

Job summary

CVS Health Corporation seeks a highly experienced RN for Mercy Care in Arizona. This full-time role focuses on prior authorization reviews for physical and behavioral health services, coordinating utilization management, and applying evidence-based criteria to determine coverage.

Strong clinical judgment, communication skills, and the ability to work across medical and behavioral health care are essential. Candidates must hold an active AZ RN license and be prepared for full-time shifts in the

Qualifications

• The candidate has 5+ years of clinical experience as an RN.
• Active and unrestricted RN licensure in AZ or Compact jurisdiction required.
• Preferred experience in utilization management and both medical and behavioral health fields.

Responsibilities

• Conduct prior authorization review of physical and behavioral health services.
• Coordinate, document, and communicate utilization/benefit management activities.
• Apply medical necessity criteria and guidelines to determine coverage determinations.
• Handle provider calls about determinations and inform members of coverage decisions.
• Gather clinical information to support appropriate care and discharge planning.
• Identify members for care management and opportunities to improve care quality.

Skills

Clinical experience

Utilization management

Communication skills

Education

RN licensure in AZ or Compact

Job description

CVS Health Corporation seeks a highly experienced RN for Mercy Care in Arizona. This full-time role focuses on prior authorization reviews for physical and behavioral health services, coordinating utilization management, and applying evidence-based criteria to determine coverage.

Strong clinical judgment, communication skills, and the ability to work across medical and behavioral health care are essential. Candidates must hold an active AZ RN license and be prepared for full-time shifts in the