Utilization Management Nurse Consultant – Behavioral Health

Job not on LinkedIn

🔥 13 hours 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 specific criteria to authorize procedures and services or initiate Medical Director referrals as needed • Review clinical information from providers • Collaborate with providers • Authorize care and escalate cases when needed • Navigate multiple systems and maintain accurate documentation • Collect and review clinical information by telephone • Provide occasional rotational weekend 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 • Commitment to attend a 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, including 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

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

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