Utilization Management Nurse Consultant – Behavioral Health

Job not on LinkedIn

🔥 30 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Apply critical thinking, evidence-based clinical criteria, and clinical practice guidelines to inpatient and outpatient services requiring precertification • Use utilization management criteria to authorize procedures and services or initiate Medical Director referrals • Collaborate with providers and authorize care • Escalate cases when needed • Navigate multiple systems and maintain accurate documentation • Collect and review clinical information from providers by telephone and computer • Provide occasional rotational weekend on-call and holiday on-call coverage

🎯 Requirements

• Active unrestricted state Registered Nurse licensure in state of residence required • 3+ years of acute behavioral health and/or substance abuse clinical nursing experience • 1+ year of concurrent review or prior authorization preferably in Behavioral Health and Substance Abuse • Mandatory 3-week training, Monday–Friday, 8:30am–5:00pm EST, with 100% participation • Associate's degree in nursing (RN) required • Ability to work occasional on-call rotational coverage on weekends and some rotational on-call holiday coverage • Proficiency with computer skills and navigating multiple systems • Dedicated workspace free of interruptions • Dependents must have separate care arrangements during work hours • Preferred: 1+ years Managed Care (MCO) experience • Preferred: 1+ year demonstrated experience working in a high-volume clinical call center environment • Preferred: Remote work experience

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay

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