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 established clinical practice guidelines for inpatient and outpatient services that require precertification.

• Employ specific criteria to authorize procedures and services, or initiate referrals to the Medical Director as necessary.

• Assess clinical information provided by healthcare professionals.

• Collaborate effectively with providers.

• Authorize care and escalate cases when appropriate.

• Navigate through various systems while ensuring accurate documentation is maintained.

• Gather and evaluate clinical information via telephone communications.

• Provide on-call coverage during weekends and holidays on a rotational basis when required.

⛳️ Requirements

• Must possess an active unrestricted state Registered Nurse license in the state of residence.

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

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

• Must commit to a mandatory 3-week training program, Monday through Friday, from 8:30 AM to 5:00 PM EST, with full attendance required.

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

• Availability for occasional on-call rotation during weekends and some holiday coverage is necessary.

• Proficient computer skills, including the ability to navigate multiple systems, are essential.

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

• Dependents must have alternative care arrangements during work hours.

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

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

• Preferred: Experience in remote work settings.

🏝️ Benefits

• Participation in CVS Health's bonus, commission, or short-term incentive program.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off benefits.

• Options for retirement savings.

• Access to wellness programs.

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