Utilization Management Nurse Consultant – Behavioral Health

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Utilize critical thinking, evidence-based clinical criteria, and clinical practice guidelines for inpatient and outpatient services that require precertification.

• Employ utilization management criteria to authorize procedures and services or initiate referrals to the Medical Director.

• Collaborate with healthcare providers to authorize care effectively.

• Escalate cases when necessary.

• Navigate various systems while ensuring accurate documentation is maintained.

• Collect and evaluate clinical information from providers via telephone and computer.

• Provide rotational weekend on-call and holiday on-call coverage as needed.

⛳️ Requirements

• An active, unrestricted Registered Nurse license in the state of residence is required.

• A minimum of 3 years of clinical nursing experience in acute behavioral health and/or substance abuse.

• At least 1 year of experience in concurrent review or prior authorization, preferably in Behavioral Health and Substance Abuse.

• Completion of a mandatory 3-week training program, Monday–Friday, from 8:30am to 5:00pm EST, with full participation required.

• An Associate's degree in nursing (RN) is required.

• Ability to provide occasional on-call rotational coverage during weekends and some holiday periods.

• Proficient computer skills and capability to navigate multiple systems.

• A dedicated workspace that is free from interruptions is necessary.

• Dependents must have separate care arrangements during work hours.

• Preferred: At least 1 year of experience in Managed Care (MCO).

• Preferred: 1 year of demonstrated experience in a high-volume clinical call center environment.

• Preferred: Experience working remotely.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program in addition to base pay.