Utilization Management Nurse Consultant – Behavioral Health

This is a fully remote position, open to applicants in Arizona, +1 more state.

📋 Description

• Utilize critical thinking, evidence-based clinical criteria, and clinical practice guidelines to assess inpatient and outpatient services that necessitate precertification.

• Employ specific criteria to authorize procedures and services or refer to the Medical Director as required.

• Collaborate with healthcare providers to gather and evaluate clinical information.

• Escalate cases when necessary.

• Navigate various systems while ensuring accurate documentation is maintained.

• Deliver utilization management support in a dynamic, computer-based setting.

• Engage in rotational weekend and holiday on-call responsibilities.

⛳️ Requirements

• An active, unrestricted state 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.

• A commitment to participate in a mandatory 3-week training program, Monday to Friday, from 8:30 AM to 5:00 PM EST, with full attendance required.

• Preferred: 1+ years of experience in Managed Care (MCO).

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

• Preferred: Experience working remotely.

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

• A Bachelor's degree in nursing (BSN) is preferred.

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

• Proficient computer skills and the ability to navigate multiple systems.

• A dedicated workspace that is free from interruptions.

• Arrangements for separate care for dependents during work hours are necessary.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Options for retirement savings.

• Wellness programs.

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