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.

• Implement specific criteria to approve procedures and services, or refer to Medical Directors when necessary.

• Collaborate with healthcare providers to authorize appropriate care.

• Elevate cases as required.

• Navigate various systems while ensuring precise documentation.

• Gather and evaluate clinical information from providers via telephone and digital means.

• Conduct utilization management reviews in a dynamic, computer-driven environment.

⛳️ Requirements

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

• Minimum of 1 year of experience in Behavioral Health and Substance Abuse concurrent review or prior authorization.

• At least 3 years of clinical experience in acute behavioral health and/or substance abuse.

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

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

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

• A dedicated workspace that is free from interruptions.

• Dependents must have alternative care arrangements during work hours.

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

• A Bachelor of Science in Nursing (BSN) is preferred.

• Over 1 year of experience in Managed Care (MCO) is preferred.

• More than 1 year of proven experience in a high-volume clinical call center environment is preferred.

• Previous remote work experience is preferred.

🏝️ Benefits

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

• Comprehensive medical coverage.

• Dental insurance options.

• Vision insurance options.

• Paid time off benefits.

• Retirement savings plans.

• Wellness programs available.

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