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 manage inpatient and outpatient treatments and services that require precertification.

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

• Gather and evaluate clinical information from healthcare providers.

• Collaborate with providers and escalate cases as appropriate.

• Navigate through various systems while ensuring accurate documentation.

• Conduct utilization management reviews in a dynamic, computer-based setting.

• Engage in sedentary desk and telephone work involving sitting, conversing, listening, and using a computer.

⛳️ Requirements

• Active and unrestricted state Registered Nurse licensure in your state of residence is mandatory.

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

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

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

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

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

• Strong computer skills and proficiency in navigating multiple systems are required.

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

• Arrangements for the care of dependents during work hours must be established.

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

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

• Preferred: Experience working remotely.

• BSN is preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.