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 to assess inpatient and outpatient services that require precertification.

• Employ specific criteria to authorize procedures and services or initiate a referral to a Medical Director when necessary.

• Collaborate with healthcare providers to authorize appropriate care.

• Escalate cases as needed.

• Navigate various systems while maintaining precise documentation.

• Gather and evaluate clinical information from providers via telephone.

• Provide occasional rotational on-call coverage during weekends and holidays.

⛳️ Requirements

• Must possess an active, unrestricted 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.

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

• Willingness to participate in a mandatory 3-week training program, Monday–Friday, from 8:30am to 5:00pm EST, with full attendance required.

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

• Proficiency in computer skills, including the ability to navigate multiple systems.

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

• A dedicated workspace that is free of interruptions is essential.

• Arrangements for care of dependents should be made during work hours.

🏝️ Benefits

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

• Medical coverage options.

• Dental coverage options.

• Vision coverage options.

• Paid time off.

• Retirement savings opportunities.

• Access to wellness programs.

• Additional resources promoting physical, emotional, and financial well-being, based on eligibility.